Hospital deaths of people aged 90 and over: end-of-life palliative care management.

BACKGROUND

In developed countries, hospital deaths at very advanced age are increasingly common. Few studies have addressed end-of-life care in very elderly patients with non-cancer chronic diseases.

OBJECTIVE

To evaluate the circumstances related to end-stage death of non-cancer nonagenarians in an acute care hospital. The results were compared with those from a sample of younger patients.

METHODS

We conducted a prospective assessment in two teaching hospitals of the written instructions for the following actions: do not resuscitate (DNR) orders, the graduation of therapeutic decisions, information provided to relatives about prognosis, total withdrawal of normal drug therapy and provision of palliative care.

RESULTS

80 patients over 89 years of age with end-stage congestive heart failure (57.5%) or dementia (42.5%) were included. The control group comprised 52 younger patients (65-74 years). DNR orders were specified in 56% of cases, graduation of therapeutic decisions in 35%, and knowledge of relatives regarding the prognosis in 61%. Drug therapy was withdrawn in 66% of cases and terminal palliative care was initiated in 69%. In the nonagenarians who died, we detected a predominance of females (p = 0.001), a higher percentage of DNR orders (p = 0.02) and a higher percentage of graduation of therapeutic measures (p = 0.02) in comparison with younger patients.

CONCLUSION

Our results indicate that there are marked differences according the palliative care provided to oldest-old patients with end-stage non-cancer chronic diseases admitted to an acute care hospital. In any case, care should be improved for both age groups.