End-of-life care and quality of dying in twenty-three acute geriatric hospital wards in Flanders, Belgium.

Date: 
04-01-2017

Authors: Rebecca Verhofstede, Tinne Smets, Joachim Cohen, Kim Eecloo, Massimo Costantini, Nele Van Den Noortgate, Luc Deliens

Source: 
Journal of pain and symptom management (2016)
Links: 
PubMed

Objectives

To describe the nursing and medical interventions performed in the last 48 hours of life and the quality of dying of patients dying in acute geriatric hospital wards.

Methods

Design: Cross-sectional descriptive study between October 1(st) 2012 and September 30(th) 2013.

Setting

Twenty-three acute geriatric wards in 13 hospitals in Flanders, Belgium.

Participants

Patients hospitalized for more than 48 hours before dying in the participating wards.

Measurements

Structured after-death questionnaires, filled out by the nurse, the physician and the family carer most involved in end-of-life care. Main outcome measures were several nursing and medical interventions reported to be performed in the last 48 hours of life and the quality of dying.

Results

Out of 993 we included 338 patients (mean age 85.7 years; 173 female). Almost 58% had dementia and nearly half were unable to communicate in the last 48 hours of their life. The most frequently continued or started nursing and medical interventions in the last 48 hours of life were measuring temperature (91.6%), repositioning (83.3%), washing (89.5%), oxygen therapy (49.7%), and intravenous fluids and nutrition (30. Shortness of breath, lack of serenity, lack of peace and lack of calm were symptoms reported most frequently by nurses and family carers.

Conclusion

Many nursing and medical interventions are continued or started in the last hours of a patient's life, which may not always be in their best interests. Furthermore, patients dying in acute geriatric wards are often affected by several symptoms.

 
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