Mortality of residents in Belo Horizonte´s long-stay institutions for the elderly: the neeed for end-of-life care
Bibliographic record
Abstract
The quality of life implies a process of death also appropriate, in the light of the concept of Good Death - occurring in the right time, with dignity and relief of suffering in its physical, psychic, social and spiritual aspects. This observational study focuses on the way 104 of 116 elderly people institutionalized died in Belo Horizonte, Minas Gerais, Brazil, in the year 2016. The death certificates and the institutional records of these elderly people were used to study the variables associated with the deceased and their family and social environment and identify factors associated with care in the final phase of life. The main social determinant of institutionalization was family insufficiency (notably the absence of a partner), with a history of mistreatment in 23% of the cases. The frequency of cognitive impairment was high at the time of admission to ILPI, as well as advanced age and loss of autonomy for the Basic Activities of Daily Living. The majority of deaths occurred in the aged ones with a profile that coincided with the one that determined the institutionalization: female, white, low schooling and absence of family support (notably a partner), as well as cognitive alterations. The proportional mortality was higher in patients over 80 years. Record deficiencies were observed, including those respecting existing pathologies and presence of geriatric syndromes. The data found indicate probable situations of suffering and qualitative and quantitative inadequacy of the care provided in the quarter preceding the death, with inadequately addressed physical suffering: persistent dyspnea and pain occurred in more than half of the elderly; fatigue and other symptoms had low frequency, probably due to under registration. Family, social and spiritual support was insufficient. Adequate quality of death was only reported in 24% of the participants. These findings confirm the literature data regarding inadequate support provided to people during the dying process. The results point to the need for additional studies, since knowing the main causes of morbidity and mortality in institutionalized elderly will contribute to a better planning of health actions, taking into account their specific needs. It concludes by the importance of discussing the terminality and empowering those responsible for supporting and comforting those who are dying.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.002 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".