Factors influencing ICU referral at the end of life in the elderly

Referral to the intensive care unit (ICU) and frequency of do-not-resuscitate (DNR) decisions at the end of life (EOL) in adult hospitalized patients a parts per thousand yen75 years and those < 75 years were examined and influencing factors in the elderly were determined. Data were prospectively collected in all adult patients who deceased during a 12-week period in 2007 and a 16-week period in 2008 at a university hospital in Belgium. Overall, 330 adult patients died of whom 33% were a parts per thousand yen75 years old. Patients a parts per thousand yen75 years old were less often referred to ICU at the EOL (42% vs. 58%, p=0.008) and less frequently died in the ICU (31% vs. 46%, p=0.012) as compared to patients < 75 years old. However, there was no difference in frequency of DNR decisions (87% vs. 88%, p=0.937) for patients dying on non-ICU wards. After adjusting for age, gender, and the Charlson comorbidity index, being admitted on a geriatric ward (OR 0.30, 95% CI 0.10-0.85, p=0.024) and having an active malignant disease (OR 0.39, 95% CI 0.19-0.78, p=0.008) were the only factors associated with a lower risk of dying in the ICU. Patients a parts per thousand yen75 years are less often referred to the ICU at the EOL as compared to patients < 75 years old. However, the risk of dying in the ICU was only lower for elderly with cancer and for those admitted to the geriatric ward

Validation of the supportive and palliative care indicators tool in a geriatric population

Background: Timely identification of patients in need of palliative care is especially challenging in a geriatric population because of prognostic uncertainty. The Supportive and Palliative Care Indicators Tool (SPICT (TM)) aims at facilitating this identification, yet has not been validated in a geriatric population. Objective: This study validates the SPICT in a geriatric patient population admitted to the hospital. Design: This is a retrospective cohort study. Setting: Subject were patients admitted to the acute geriatric ward of a Belgian university hospital between January 1 and June 30, 2014. Measurements: Data including demographics, functional status, comorbidities, treatment limitation decision (TLD), and one-year mortality were collected. SPICT was measured retrospectively by an independent assessor. Results: Out of 435 included patients, 54.7% had a positive SPICT, using a cut-off value of 2 for the general indicators and a cut-off value of 1 for the clinical questions. SPICT-positive patients were older (p = 0.033), more frequently male (p = 0.028), and had more comorbidities (p = 0.015) than SPICT-negative patients. The overall one-year mortality was 32.2%, 48.7% in SPICT-positive patients, and 11.5% in SPICT-negative patients (p < 0.001). SPICT predicted one-year mortality with a sensitivity of 0.841 and a specificity of 0.579. The area under the curve of the general indicators (0.758) and the clinical indicators of SPICT (0.748) did not differ (p = 0.638). In 71.4% of SPICT-positive cases, a TLD was present versus 26.9% in SPICT-negative cases (p < 0.001). Conclusion: SPICT seems to be valuable for identifying geriatric patients in need of palliative care as it demonstrates significant association with one-year mortality and with clinical survival predictions of experienced geriatricians, as reflected by TLDs given

Perspectives of family members on planning end-of-life care in the older palliative patient

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Terminal care in older patients in hospital : development of a quality indicator set and its first application in a retrospective comparison of patients treated in acute geriatric unit and a palliative care unit of a Belgian university hospital

Background: Care at the end-of-life of geriatric inpatients is of increasing importance. Nevertheless, limited research has been conducted on this subject so far. Objectives: To compose a set of quality indicators (QIs) which measure the quality of terminal care for geriatric inpatients and to compare the quality of end-of-life care between the Acute Geriatric Unit (AGU) and the Palliative Care Unit (PCU). Design: Retrospective case study. Setting: Belgian university hospital. Participants: Patients >75 years, who died an expected death between January 1st 2009 and December 31st 2010 at the AGU or the PCU. Measurements: QIs collected through systematic literature search and the Delphi method. Results: A set of 17 QIs was composed. At the AGU, 58 patients were included (QI score generally varying between 0 and 70%) and at the PCU 59 (QI score generally varying between 50 and 100%). The PCU scored significantly higher for 5 of the 17 QIs: pain screening, oral care and anxiety screening (all p < .001), prescription of rescue medication (p < .01), and pain treatment (p < .05). Both units scored low on delirium screening, spiritual care, and involvement of the general practitioner (GP) in care planning. Conclusion: In-hospital care for the dying geriatric patient could be optimized further. Both departments should pay more attention to delirium screening, spiritual care, and the involvement of the GP in the care planning. At the AGU it is recommended that items regarding pain screening and treatment, oral care, and anxiety screening should routinely be included in the dying patients’ records