End-of-life care in hospitalized patients with dementia

Abstract

Background: As the aging population grows, the care provided to patients with dementia at the end of life represents a critical area of geriatric and palliative care. This study aimed to describe the care provided to hospitalized patients with dementia who died during their hospital stay.

Methods: A retrospective cohort study was conducted at a teaching hospital in Sydney, Australia. The study included patients with dementia who died during hospitalization. Data were collected on demographic characteristics, clinical management, and documentation of key care processes, including advance care planning, resuscitation orders, and discussions about oral nutrition and hydration.

Results: The study cohort comprised patients with a mean age of 87.2 ± 7.2 years (n = 100), 63% of whom had lived in nursing homes. Geriatric medicine teams cared for a large proportion of patients (63%), and their patients were more likely to be older, from a nursing home, and to die from pneumonia compared to those admitted in palliative care teams. Recommended care processes were implemented in the majority of patients with advance care planning and resuscitation orders being the most frequently documented, and discussions about oral nutrition and hydration the least frequent.

Conclusion: This study highlights the integral role of geriatrics services in providing end-of-life care for hospitalized patients with dementia, and underscore opportunities to enhance the quality and consistency of care for this population.

Keywords: dementia; end-of-life; nursing homes; palliative care.

Figure 1.

Performance of care processes during the hospital admission of inpatients dying with dementia. The numbers on the x axis refer to the care processes listed as follows: 1. Presence of advance care plan within last 12 months. 2. Documentation of advance care planning discussions this admission/completion of not for resuscitation paper form during admission. 3. Documentation of discussions with person responsible/next of kin within 48 hours prior to death. 4. Cessation of active interventions in last 48 hours of life. 5. No medical emergency team calls during final 48 hours of life. 6. Deprescribing of primary prophylaxis medications. 7. Assessment for end of life symptoms within last 48 hours of life. 8. Evidence of prescription of as required medications to manage end of life symptoms. 9. Documented evidence of patient’s ability to maintain oral nutrition/hydration discussed with patient and/or next of kin. 10. Cessation of routine measurement of vital signs in last 24 hours. 11. Provision of oral health care.