- Email: [email protected]
Beyond hospital care: More efficient care of the chronic terminal elderly
S38
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S20–S80
in 1.3% vs 11.9% (P = 0.01). Doses for sedation maintenance were significantly lower after the guideline was implemented (9.86 vs 18.67 mg, P < 0.001). Conclusions.– Dyspnea is the main trigger for palliative sedation. Few changes were found immediately after the guideline was implemented, except for significant improvements in midazolam dosing and a decrease of palliative care team involvement. More time is needed to assess long term changes. http://dx.doi.org/10.1016/j.eurger.2013.07.123 P060
Euthanasia, palliative care, hospice and elderly in Luxembourg. Ethical and numerical considerations over 3 years J.-C. Leners Hospice House Omega, 2211 Maureen Lane, Houghton, MI 49931, Madrid, Spain Since 2009, a new law on euthanasia was introduced. From that time on, patients can ask under specific conditions for euthanasia or assisted suicide. In 4 years, the number of euthanasia doubled from 2010 till 2012 and all where above 60 and 20% above 80 years. As euthanasia was applied at home, in nursing homes and in hospitals shows a possible trend of lower threshold for its request and a possible higher acceptance in the medical field to practice it. On the other hand we have seen a tremendous increase in the demands (more than 500 in 2012) for specific palliative care, which is taking in charge by the health insurance since 2009 and is considered as a right for all patients. 85% are above the age of 75 and some 20% of the palliative care is applied for longer than 6 months. We consider that a palliative care request is largely done for economic reasons and medical indications, but as there is no strict definition, the demands will continue to grow. The most encouraging results for elderly in Luxembourg is the hospice. For the 14 beds’ institution, we conclude that for 210 admissions in two years, half are aged 70 or more and even 1/3 is above 80 years. This can be seen actually as the most recent achievement for quality in end of life. http://dx.doi.org/10.1016/j.eurger.2013.07.124 P061
Pain in terminal dementia M. Herrera Abián , G. Megías Baeza , B. Alvira Rasal , E. García Gómez , F. Soria Perdomo , A. Jiménez Rodríguez Hospital Universitario Infanta Elena, Madrid, Spain Introduction.– Acute and chronic pain is a symptom frequently underdiagnosed and undertreated in elderly patients (especially in demented population). The prevalence of pain in geriatric residences varies between 45 and 80%. However changes in pain perception in aged patient are clinically insignificant. Aim.– Study of severe demented patients with or without terminal pathology (potentially painful). Evaluation of analgesic treatment in this group of patients. Methods.– Retrospective study of severe demented patients followed up during one year in our acute care unit. Data collected regarding origin (geriatric residence or family home), medical treatment, dysphagia, confusional state or behavioral symptoms. Results.– There were evaluated 74 patients with severe dementia (83% living in geriatric residences). Mean diagnosis: oncological pathology (43%), osteomuscular pathology (87%); fractures (42%). Dysphagia diagnosed in 56%. Analgesic treatment in 42% (any level of analgesia): 26% of them with major opioids (82% with transdermal fentanyl with transmucosal fentanyl citrate rescue in 42%
of such patients). Confusional states seen in 74% of patients. Pain evaluation scales used in 38% of patients. Conclusions.– There is a high prevalence of dementia and associated behavioral symptoms and there is still a lack of pain diagnosis in management in these patients. Pain is undertreated even knowing that the patient has potentially painful pathologies. Third step analgesics are underused maybe because misconceptions or lack of experience. Transdermal and transmucosal fentanyl citrate are good options and are frequently used by our team, especially in demented patients with a high prevalence of dysphagia. http://dx.doi.org/10.1016/j.eurger.2013.07.125 P062
Beyond hospital care: More efficient care of the chronic terminal elderly M. Herrera Abián , G. Megías Baeza , B. Alvira Rasal , E. García Gómez , F. Soria Perdomo , A. Jiménez Rodríguez Hospital Universitario Infanta Elena, Madrid, Spain Aim.– To describe how Palliative Care Unit works in coordination with Geriatrics Service taking care of terminal elderly patients in three different levels: inpatient, geriatric residence and day hospital. Methods.– Descriptive study of the first year of work in 2012. Data collected regarding chronic terminal pathologies in geriatric residence patients and medical procedures performed in day hospital such as paracentesis, thoracentesis or transfusions. Consults (at least monthly) and phone consultation with geriatric residence physician. Results.– Eighty-seven patients all living in geriatric residence, hospitalized at least in one opportunity. Oncological pathology (37%), non-oncological pathology (63%): from which 78% with terminal dementia, 12% COPD; 8% heart failure; 2% renal failure. All patients with life expectancy of less than 6 months. Day Hospital visited by 21% (procedures performed: paracentesis (81%); thoracentesis (2%) and transfusions (17%). None of the patient visited emergency room (ER). Forty-three percent of patient in geriatric resident received phone consultation. Thirty-seven percent of patient died in the hospital. Discussion.– There is an increasing prevalence of chronic terminal illnesses in geriatric residence. This is why Palliative Care Unit in cooperation with Geriatric Service proposes a model which guarantees continuity of assistance in palliative care with no extra cost. Palliative care specialist follows patient during hospitalization and after discharge keeps consultation and makes necessary procedures in day hospital. Conclusions.– The work made before by three different physicians is now performed by only one, programming different procedures and avoiding unnecessary consultation and ER visits. Saves primary care resources and empowers continuity of assistance. http://dx.doi.org/10.1016/j.eurger.2013.07.126 P063
The regional use of end of life orders in nursing homes – a cross country survey in Austria M. Reicher , E.H. Pilgram , R.E. Roller Department Of Ger.–MU, Graz; Ger. Hospital Albert Schweitzer, Graz, Austria Introduction.– The increasing number of older – disabled people necessitates development within caring structures. Despite the challenging medical situation of these people, support is limited to primary care physicians, not on call on regular basis for nursing home residents. As a consequence many of the nursing home residents are admitted to emergency departments in the last hours
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S20–S80
in 1.3% vs 11.9% (P = 0.01). Doses for sedation maintenance were significantly lower after the guideline was implemented (9.86 vs 18.67 mg, P < 0.001). Conclusions.– Dyspnea is the main trigger for palliative sedation. Few changes were found immediately after the guideline was implemented, except for significant improvements in midazolam dosing and a decrease of palliative care team involvement. More time is needed to assess long term changes. http://dx.doi.org/10.1016/j.eurger.2013.07.123 P060
Euthanasia, palliative care, hospice and elderly in Luxembourg. Ethical and numerical considerations over 3 years J.-C. Leners Hospice House Omega, 2211 Maureen Lane, Houghton, MI 49931, Madrid, Spain Since 2009, a new law on euthanasia was introduced. From that time on, patients can ask under specific conditions for euthanasia or assisted suicide. In 4 years, the number of euthanasia doubled from 2010 till 2012 and all where above 60 and 20% above 80 years. As euthanasia was applied at home, in nursing homes and in hospitals shows a possible trend of lower threshold for its request and a possible higher acceptance in the medical field to practice it. On the other hand we have seen a tremendous increase in the demands (more than 500 in 2012) for specific palliative care, which is taking in charge by the health insurance since 2009 and is considered as a right for all patients. 85% are above the age of 75 and some 20% of the palliative care is applied for longer than 6 months. We consider that a palliative care request is largely done for economic reasons and medical indications, but as there is no strict definition, the demands will continue to grow. The most encouraging results for elderly in Luxembourg is the hospice. For the 14 beds’ institution, we conclude that for 210 admissions in two years, half are aged 70 or more and even 1/3 is above 80 years. This can be seen actually as the most recent achievement for quality in end of life. http://dx.doi.org/10.1016/j.eurger.2013.07.124 P061
Pain in terminal dementia M. Herrera Abián , G. Megías Baeza , B. Alvira Rasal , E. García Gómez , F. Soria Perdomo , A. Jiménez Rodríguez Hospital Universitario Infanta Elena, Madrid, Spain Introduction.– Acute and chronic pain is a symptom frequently underdiagnosed and undertreated in elderly patients (especially in demented population). The prevalence of pain in geriatric residences varies between 45 and 80%. However changes in pain perception in aged patient are clinically insignificant. Aim.– Study of severe demented patients with or without terminal pathology (potentially painful). Evaluation of analgesic treatment in this group of patients. Methods.– Retrospective study of severe demented patients followed up during one year in our acute care unit. Data collected regarding origin (geriatric residence or family home), medical treatment, dysphagia, confusional state or behavioral symptoms. Results.– There were evaluated 74 patients with severe dementia (83% living in geriatric residences). Mean diagnosis: oncological pathology (43%), osteomuscular pathology (87%); fractures (42%). Dysphagia diagnosed in 56%. Analgesic treatment in 42% (any level of analgesia): 26% of them with major opioids (82% with transdermal fentanyl with transmucosal fentanyl citrate rescue in 42%
of such patients). Confusional states seen in 74% of patients. Pain evaluation scales used in 38% of patients. Conclusions.– There is a high prevalence of dementia and associated behavioral symptoms and there is still a lack of pain diagnosis in management in these patients. Pain is undertreated even knowing that the patient has potentially painful pathologies. Third step analgesics are underused maybe because misconceptions or lack of experience. Transdermal and transmucosal fentanyl citrate are good options and are frequently used by our team, especially in demented patients with a high prevalence of dysphagia. http://dx.doi.org/10.1016/j.eurger.2013.07.125 P062
Beyond hospital care: More efficient care of the chronic terminal elderly M. Herrera Abián , G. Megías Baeza , B. Alvira Rasal , E. García Gómez , F. Soria Perdomo , A. Jiménez Rodríguez Hospital Universitario Infanta Elena, Madrid, Spain Aim.– To describe how Palliative Care Unit works in coordination with Geriatrics Service taking care of terminal elderly patients in three different levels: inpatient, geriatric residence and day hospital. Methods.– Descriptive study of the first year of work in 2012. Data collected regarding chronic terminal pathologies in geriatric residence patients and medical procedures performed in day hospital such as paracentesis, thoracentesis or transfusions. Consults (at least monthly) and phone consultation with geriatric residence physician. Results.– Eighty-seven patients all living in geriatric residence, hospitalized at least in one opportunity. Oncological pathology (37%), non-oncological pathology (63%): from which 78% with terminal dementia, 12% COPD; 8% heart failure; 2% renal failure. All patients with life expectancy of less than 6 months. Day Hospital visited by 21% (procedures performed: paracentesis (81%); thoracentesis (2%) and transfusions (17%). None of the patient visited emergency room (ER). Forty-three percent of patient in geriatric resident received phone consultation. Thirty-seven percent of patient died in the hospital. Discussion.– There is an increasing prevalence of chronic terminal illnesses in geriatric residence. This is why Palliative Care Unit in cooperation with Geriatric Service proposes a model which guarantees continuity of assistance in palliative care with no extra cost. Palliative care specialist follows patient during hospitalization and after discharge keeps consultation and makes necessary procedures in day hospital. Conclusions.– The work made before by three different physicians is now performed by only one, programming different procedures and avoiding unnecessary consultation and ER visits. Saves primary care resources and empowers continuity of assistance. http://dx.doi.org/10.1016/j.eurger.2013.07.126 P063
The regional use of end of life orders in nursing homes – a cross country survey in Austria M. Reicher , E.H. Pilgram , R.E. Roller Department Of Ger.–MU, Graz; Ger. Hospital Albert Schweitzer, Graz, Austria Introduction.– The increasing number of older – disabled people necessitates development within caring structures. Despite the challenging medical situation of these people, support is limited to primary care physicians, not on call on regular basis for nursing home residents. As a consequence many of the nursing home residents are admitted to emergency departments in the last hours