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BMC Palliat Care. 2019 Dec 27;18(1):117. doi: 10.1186/s12904-019-0510-x.

The last week of life of nursing home residents with advanced dementia: a retrospective study.

Author information

1
Lino Maestroni Foundation, Palliative Medicine Research Institute, via Palestro 1, 26100, Cremona, Italy.
2
Department of Health and Social Services Polo Lombardia 2, Don Carlo Gnocchi Foundation ONLUS, Via Palazzolo, 21, 20149, Milan, Italy.
3
Intensive Care Unit, SS Antonio e Biagio e Cesare Arrigo Hospital, Via Venezia, 16, 15121, Alessandria, Italy.
4
University of Milan, section of Don Carlo Gnocchi Foundation, Via A. Capecelatro, 66, 20148, Milan, Italy.
5
Agenzia Continuità Ospedale Territorio, Azienda Ospedaliero- Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
6
Neuro-Rehabilitation and Alzheimer Disease Evaluation Unit, Figlie di San Camillo Hospital, Via F. Filzi , 56, 26100, Cremona, Italy.
7
Rehabilitation and Alzheimer Disease Evaluation Unit, Ancelle della Carità Hospital, Via G. Aselli, 14, Cremona, Italy.
8
Intensive Care Unit Geriatric, AOU Careggi-Largo Brambilla,3, 50134, Florence, Italy.
9
Geriatric Institute Pio Albergo Trivulzio, via Trivulzio, 15, 20146, Milan, Italy.
10
Istituto Giano, Via Stazzo Quadro 7, 00060 Riano (Rm), Milan, Italy.
11
Italian Foundation of Leniterapia (FILE), Via San Niccolò, 1, 50125, Florence, Italy.
12
Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy. lorena.charrier@unito.it.
13
Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy.
14
SUPSI, Manno, Switzerland.

Abstract

BACKGROUND:

Barriers to palliative care still exist in long-term care settings for older people, which can mean that people with advanced dementia may not receive of adequate palliative care in the last days of their life; instead, they may be exposed to aggressive and/or inappropriate treatments. The aim of this multicentre study was to assess the clinical interventions and care at end of life in a cohort of nursing home (NH) residents with advanced dementia in a large Italian region.

METHODS:

This retrospective study included a convenience sample of 29 NHs in the Lombardy Region. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the 7 days before death.

RESULTS:

Most residents (97.1%) died in the NH. In the 7 days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs were prescribed. Fifty-seven percent of residents had an acknowledgement of worsening condition recorded in their clinical records, a median of 4 days before death.

CONCLUSIONS:

Full implementation of palliative care was not achieved in our study, possibly due to insufficient acknowledgement of the appropriateness of some drugs and interventions, and health professionals' lack of implementation of palliative interventions. Future studies should focus on how to improve care for NH residents.

KEYWORDS:

Dementia; Nursing homes; Palliative care

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