Symptoms and care of dying elderly patients in an acute hospital.
BACKGROUND
We aimed to study the symptoms and the care of elderly patients dying in an acute hospital in Singapore.


METHODS
Over a one year period, we retrospectively studied all patients admitted to the Department of Geriatric Medicine and all other patients aged more than 75 years old who were admitted and died during the same admission to all other units in an acute hospital. There were 189 such patients. Demographical data, information on the patients' background and prevailing medical problems, symptoms, intervention and treatment methods were obtained from the patients' medical records and analysed.


RESULTS
The patients were frail and old. 17 percent had bedsores and 20 percent had limb contractures noted at the point of admission. 20 percent had known terminal disease. 88 percent of the deaths were expected and 12 percent unexpected. In spite of the deaths being anticipated, 25 percent of them were subjected to cardiopulmonary resuscitation and 17 percent were intubated at the point of collapse. The majority (81 percent) of relatives of the 160 patients whose deaths were anticipated and had family had no acceptance problems. 52 (31 percent) of the 167 expected deaths had input from palliative care. These patients were more dependent, (p-value equals 0.018; odds ratio [OR] = 2.5; 95 percent confidence interval [CI] 1.2-5.2), less likely to undergo resuscitation (p-value is less than 0.001; OR = 0.16; 95 percent CI, 0.06-0.44), and were more likely to be on treatment for their symptoms (p-value is equal to 0.001; OR = 7.7; 95 percent CI, 2.1-28.8).


CONCLUSIONS
The common symptoms experienced by the elderly at the end of life are difficulty with breathing, fever, pain and respiratory secretions. A number of patients were not on any treatment for these problems though the proportion is less where there is palliative input.
Seah
S T A
ST
Department of Geriatric Medicine, Alexandra Hospital, 378 Alexandra Road, Singapore 159964.
Low
J A
JA
Chan
Y H
YH
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008020:Life Support Care / Q000706:statistics & numerical data; D008297:Male; D010166:Palliative Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*; D019452:Terminally Ill / Q000145:classification; D014600:Utilization Review