[Nursing homes as arenas of terminal care--how do we do in practice?]

Abstract

40% of all deaths in Norway take place in nursing homes, more than in any other European country. The nursing homes are suitable places for the terminally ill old, provided that they are met by caregivers with the necessary skills in and resources for palliative care. A recently published study from Bergen Red Cross Nursing Home showed that the vast majority of the old in their final days or hours of life need palliative treatment with morphine and other symptom-relieving drugs. 85% of the deaths were expected, a fact that facilitates preparation, communication, ethical decisions and pain control. The most frequent symptoms are dyspnoea and death rattle. Dyspnoea based on terminal heart failure is relieved with subcutaneous application of morphine. The secretions of death rattle are best reduced with hyoscine hydrobromide (scopolamine). In the patient's terminal phase, the crucial factor for proper palliative care is the doctor's skills and commitment. Avoiding the strains associated with unnecessarily prolonging the death process, adequate symptom relief and prevention of unnecessary and strongly annoying transfer of the dying old to hospitals should be aimed for in Norwegian nursing homes.