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J Pain Symptom Manage. 2018 May;55(5):1304-1312. doi: 10.1016/j.jpainsymman.2017.12.489. Epub 2018 Jan 2.

Factors Associated With Symptom Relief in End-of-Life Care in Residential Care Homes: A National Register-Based Study.

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Department of Nursing, Umeå University, Umeå, Sweden. Electronic address:
Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden; Kalmar County Hospital, Kalmar, Sweden.
Department of Nursing, Umeå University, Umeå, Sweden; Department of Learning, Informatics, Management and Ethics/MMC, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Science, Faculty of Medicine, The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.
Department of Nursing, Umeå University, Campus Skellefteå, Umeå, Sweden; The Arctic Research Centre, Umeå University, Umeå, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.



Residential care homes (RCHs) are a common place of death. Previous studies have reported a high prevalence of symptoms such as pain and shortness of breath among residents in the last week of life.


The aim of the study was to explore the presence of symptoms and symptom relief and identify factors associated with symptom relief of pain, nausea, anxiety, and shortness of breath among RCH residents in end-of-life care.


The data consisted of all expected deaths at RCHs registered in the Swedish Register of Palliative Care (N = 22,855). Univariate and multiple logistic regression analyses were conducted.


Pain was reported as the most frequent symptom of the four symptoms (68.8%) and the one that most often had been totally relieved (84.7%) by care professionals. Factors associated with relief from at least one symptom were gender; age; time in the RCH; use of a validated pain or symptom assessment scale; documented end-of-life discussions with physicians for both the residents and family members; consultations with other units; diseases other than cancer as cause of death; presence of ulcers; assessment of oral health; and prescribed pro re nata injections for pain, nausea, and anxiety.


Our results indicate that use of a validated pain assessment scale, assessment of oral health, and prescribed pro re nata injections for pain, nausea, and anxiety might offer a way to improve symptom relief. These clinical tools and medications should be implemented in the care of the dying in RCHs, and controlled trials should be undertaken to prove the effect.


Nursing homes; older persons; palliative care; quality of care; register study; symptom relief

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