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16-05-2012 | Hospice medicine | Article

End-of-life symptoms, treatment vary little by age


Free abstract

MedWire News: In the last 3 days of life, there are few differences between older and younger patients in terms of symptoms, clinical signs, or treatment, research indicates.

The exceptions were falls and peripheral edema, both of which were more common in people aged 85 years and over than in those aged 65-84 years, while delirium was under-reported in all patients.

The study, by Simen Steindal (Diakonhjemmet University College, Oslo, Norway) and team, aimed to increase knowledge about the provision of end-of-life care in elderly patients in hospital.

The researchers retrospectively analyzed electronic medical records for 190 patients who died from cancer or other causes during inpatient admission to a general hospital. All patients had been assessed in the last 3 days of life using the 72-item Resident Assessment Instrument for Palliative Care, a comprehensive questionnaire.

The patients were dichotomized into "young old" (median 79 years, range 65-84 years; n=101) and "oldest old" (median 89 years, range 85-100; n=89) groups.

The mean length of hospital stay was 12.6 days in young‑old and 10.0 days in oldest‑old patients, a nonsignificant difference. Young-old patients were more likely to have a cancer diagnosis and to be married and living with family members, while oldest-old patients were more likely to be women. Other baseline characteristics did not differ between the two age groups.

In terms of signs and symptoms, there were no significant differences between the age groups in terms of frequency of pain, dyspnea, nausea, vomiting, fever, and urinary and fecal incontinence.

However, peripheral edema was more frequent in the oldest-old than the young-old patients (33.7 vs 26.7%) as was the prevalence of falls in the previous 30 days (34.8 vs 12.9%). Signs of delirium were documented in 13.9% of the young-old patients and 16.7% of the oldest-old, but this difference was not statistically significant.

Finally, there were no significant differences between the two age groups with regard to treatment, although there was a trend toward more frequent suctioning in the young-old patients compared with the oldest-old patients (20.8 vs 11.2%).

Commenting on their study, which appears in the International Journal of Older People Nursing, Steindal et al say they believe that delirium was under-reported and suggest: "healthcare workers may misinterpret the moaning, groaning, and grimacing of dying patients that frequently accompany delirium as pain."

They conclude: "Increased knowledge about delirium and training in the use of specific assessments tools such as the Confusion Assessment Method could increase registered nurses' ability to identify delirium."

By Joanna Lyford

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