title: The care of the very old in the last three days of life.
abstract: BACKGROUND
  As life expectancy has increased, the age at which people are dying has also increased. There is limited knowledge of the experience of dying of the very old. We sought to examine the last 3 days of life for the very old, dying in a palliative care unit, focusing upon symptom burden and medications prescribed.
  
  
  METHODS
  A retrospective review of medical records of consecutive patients who died in two inpatient palliative care units. Information collated included demographic and medical information, symptom data, and medications (opioids, benzodiazepines and antipsychotics) administered. Analysis comparing patients aged 80 years and older (cases) and those in the median age range of the treating palliative care units, that is, those aged 50 to 70 years (comparators) were conducted.
  
  
  RESULTS
  One hundred five cases and 100 comparators were identified. Analysis revealed a significantly shorter length of stay in the cases (13 days) compared to comparators (19 days; p≤0.01).) In the last 3 days, cases received significantly less parenteral morphine equivalents (82.8 versus 170.5 mg, p<0.05), midazolam (12.1 versus 19.1 mg, p<0.05), and lorazepam equivalents (0.9 versus 2.4 mg, p<0.01). Overall, symptom profiles between the groups were similar.
  
  
  CONCLUSIONS
  The very old appear to have a distinct experience of palliative inpatient care with shorter admissions, and lower requirements for medication. Reasons for lower medication requirements are discussed, and the need for future prospective studies in this area is highlighted. A better understanding of the needs of this population at end of life will enable adequate service planning and improved care.
authors.affiliation: Centre for Palliative Care, St. Vincent's Hospital & University of Melbourne, Fitzroy, Victoria, Australia.
authors.forename: Nadia Mohamad
authors.initials: NM
authors.lastname: Rashidi
authors.forename: Rachel Dolores
authors.initials: RD
authors.lastname: Zordan
authors.forename: Eleanor
authors.initials: E
authors.lastname: Flynn
authors.forename: Jennifer A M
authors.initials: JA
authors.lastname: Philip
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D014151:Anti-Anxiety Agents / Q000008:administration & dosage*; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D001569:Benzodiazepines / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D018434:Sickness Impact Profile; D013727:Terminal Care / Q000379:methods*; D014739:Victoria
chemical_list: D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines