The last week of life of nursing home residents with advanced dementia: A retrospective study

Franco Toscani, Silvia Finetti, Fabrizio Giunco, Ines Basso, Debora Rosa, Francesca Pettenati, Alessandro Bussotti, Daniele Villani, Simona Gentile, Lorenzo Boncinelli, Massimo Monti, Sandro Spinsanti, Massimo Piazza, Lorena Charrier, Paola Di Giulio

Research output: Contribution to journalArticlepeer-review


Background: Barriers to palliative care still exist in long-term care settings for older people, which can mean that people with advanced dementia may not receive of adequate palliative care in the last days of their life; instead, they may be exposed to aggressive and/or inappropriate treatments. The aim of this multicentre study was to assess the clinical interventions and care at end of life in a cohort of nursing home (NH) residents with advanced dementia in a large Italian region. Methods: This retrospective study included a convenience sample of 29 NHs in the Lombardy Region. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the 7 days before death. Results: Most residents (97.1%) died in the NH. In the 7 days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs were prescribed. Fifty-seven percent of residents had an acknowledgement of worsening condition recorded in their clinical records, a median of 4 days before death. Conclusions: Full implementation of palliative care was not achieved in our study, possibly due to insufficient acknowledgement of the appropriateness of some drugs and interventions, and health professionals' lack of implementation of palliative interventions. Future studies should focus on how to improve care for NH residents.

Original languageEnglish
Article number117
JournalBMC Palliative Care
Issue number1
Publication statusPublished - Dec 27 2019


  • Dementia
  • Nursing homes
  • Palliative care

ASJC Scopus subject areas

  • Medicine(all)


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