 |
Improving care provided to elderly patients affected by end-stage chronic diseases
dying in acute hospitals is a health priority. Investigators evaluated the circumstances
related to death in 102 end-stage non-cancer patients with dementia (37%) or
congestive heart failure (64%) in two acute care hospitals, as well as caregiver
opinions about their deaths.
Caregiver opinions were obtained by questionnaire. Data was collected on do
not resuscitate (DNR) orders, decisions on care interventions, information provided
to relatives about the patient's prognosis, total withdrawal of normal drug
therapy, and palliative care.
Caregivers stated that the clinical information was accurate in about two-thirds
of the cases, and symptom control was reported good in 55%. Their perception
of pain persisted in 14% and uncontrolled dyspnea (shortness of breath) in 45%.
The end-of-life care was assessed as: excellent 30.5%, good 36%, fairly good
25.5%, bad 6%, and very bad 2%. DNR orders were specified in 89% of patients,
decisions concerning the intensity of care in 64%, and 80% of relatives were
aware of the patient's prognosis. Drug therapy was withdrawn in 64% of cases,
and terminal palliative care was initiated in 79.5%.
This study suggests that some aspects of the palliative care provided to elderly
patients with end-stage chronic diseases in acute care hospitals can be improved.
These include clinical information provided to caregivers and symptom control.
Formiga F, Olmedo C, Lopez-Soto A, Navarro M, Culla A, Pujol R. Adapted from
Palliat Med. 2007 Jan;21(1):35-40.
PMID 17169958
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed
Credit: PubMed, developed by the National Center for Biotechnology Information
(NCBI) at the
National Library of Medicine (NLM).
|