Dying with advanced dementia in long-term care geriatric institutions: A retrospective study

Paola Di Giulio, Franco Toscani, Daniele Villani, Cinzia Brunelli, Simona Gentile, Patrizia Spadin

Research output: Contribution to journalArticle

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Abstract

Objective: The aim of this study is to describe the last month of life of severely demented elders in long-term care institutions, and the clinical decisions in the management of their end-of-life events. Design: Retrospective exploratory study. Setting: Seven Italian long-term care institutions with more than 200 beds. Participants: One hundred forty-one patients with advanced (FAST stage = 7c) dementia (Alzheimer disease, vascular, other kinds of dementia, severe cognitive impairment). Measurement: Diagnosis, Mini-Mental State Examination, cause of death. Data were collected from clinical and nursing records referring to the last 30 days of life: symptoms and signs, intensity and incidence, treatments (antibiotics, analgesics, anxiolytics, antidepressants, artificial nutrition/hydration, and use of restraints); the last 48 hours: cardiopulmonary resuscitation attempts and life-sustaining drugs. Results: Patients were given antibiotics (71.6%), anxiolytics (37.1%), and antidepressants (7.8%). Twenty-nine patients (20.5%) were tube- or percutaneous endoscopic gastrostomy (PEG)-fed. Most patients (66.6%) were also parenterally hydrated (72 intravenously, 15 by hypodermoclysis). Some form of physical restraint was used for 58.2% (bed-rails and other immobilizers). Almost half of the patients had pressure sores. In general, attention to physical suffering was fairly good, but during the last 48 hours a number of interventions could be considered inappropriate for these patients: tube feeding (20.5%), intravenous hydration (66.6%), antibiotics (71.6%), and life-sustaining drugs (34.0%). Conclusions: Some indicators imply a less than optimal quality of care (restraints, pressure sores, psychoactive drugs, and the lack of documentation of shared decision-making) and suggest that far advanced demented patients are not fully perceived as "terminal."

Original languageEnglish
Pages (from-to)1023-1028
Number of pages6
JournalJournal of Palliative Medicine
Volume11
Issue number7
DOIs
Publication statusPublished - Sep 1 2008

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Long-Term Care
Geriatrics
Dementia
Retrospective Studies
Pressure Ulcer
Anti-Anxiety Agents
Anti-Bacterial Agents
Antidepressive Agents
Hypodermoclysis
Nursing Records
Physical Restraint
Gastrostomy
Quality of Health Care
Psychotropic Drugs
Cardiopulmonary Resuscitation
Enteral Nutrition
Pharmaceutical Preparations
Documentation
Signs and Symptoms
Blood Vessels

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Di Giulio, P., Toscani, F., Villani, D., Brunelli, C., Gentile, S., & Spadin, P. (2008). Dying with advanced dementia in long-term care geriatric institutions: A retrospective study. Journal of Palliative Medicine, 11(7), 1023-1028. https://doi.org/10.1089/jpm.2008.0020

Dying with advanced dementia in long-term care geriatric institutions : A retrospective study. / Di Giulio, Paola; Toscani, Franco; Villani, Daniele; Brunelli, Cinzia; Gentile, Simona; Spadin, Patrizia.

In: Journal of Palliative Medicine, Vol. 11, No. 7, 01.09.2008, p. 1023-1028.

Research output: Contribution to journalArticle

Di Giulio, P, Toscani, F, Villani, D, Brunelli, C, Gentile, S & Spadin, P 2008, 'Dying with advanced dementia in long-term care geriatric institutions: A retrospective study', Journal of Palliative Medicine, vol. 11, no. 7, pp. 1023-1028. https://doi.org/10.1089/jpm.2008.0020
Di Giulio, Paola ; Toscani, Franco ; Villani, Daniele ; Brunelli, Cinzia ; Gentile, Simona ; Spadin, Patrizia. / Dying with advanced dementia in long-term care geriatric institutions : A retrospective study. In: Journal of Palliative Medicine. 2008 ; Vol. 11, No. 7. pp. 1023-1028.
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