title: The last two days of life of nursing home patients--a nationwide study on causes of death and burdensome symptoms in The Netherlands.
abstract: OBJECTIVE
  The aim of this study was to identify the direct causes of death and to evaluate the presence of burdensome symptoms in the last two days of life of terminally ill nursing home (NH) patients.
  
  
  METHODS
  Prospective study of patients with a maximum life-expectancy of six weeks in 16 nursing homes representative for The Netherlands (n = 463). Symptoms were measured after death in conscious patients with the Edmonton Symptom Assessment Scale (ESAS) and the Resident Assessment Instrument Minimum Data-Set Palliative Care (RAI MDS-PC draft 1.8). Direct causes of death were assessed in all patients.
  
  
  RESULTS
  Most patients died from pneumonia, renal failure or dehydration. Loss of consciousness was common. The prevalence of burdensome symptom(s) at 48 and 24 hours before death was 51.3 and 28.4%, respectively.
  
  
  CONCLUSIONS
  In practice, it appears that, for many patients, the last days of life are spent unconscious or conscious with one or more burdensome symptom(s), which suggests the potential for improvement of symptom management.
authors.affiliation: Department of Nursing Home Medicine, Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
authors.forename: Hella E
authors.initials: HE
authors.lastname: Brandt
authors.forename: Marcel E
authors.initials: ME
authors.lastname: Ooms
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.forename: Gerrit
authors.initials: G
authors.lastname: van der Wal
authors.forename: Miel W
authors.initials: MW
authors.lastname: Ribbe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013727:Terminal Care / Q000706:statistics & numerical data*; D019452:Terminally Ill / Q000706:statistics & numerical data*