title: Type and course of symptoms demonstrated in the terminal and dying phases by people with dementia in nursing homes.
abstract: BACKGROUND
  In all, 39 % of people living in Swiss nursing homes suffer from dementia. Detailed data about type and course of symptoms displayed by these patients in their terminal phase are lacking.
  
  
  METHODS
  This descriptive, retrospective study analysed 65 nursing documents from deceased people with dementia in four nursing homes in the canton of Zurich, Switzerland.
  
  
  RESULTS
  Difficulties with mobility (81 %), pain (71 %) and sleep disturbance (63 %) were the most frequent of the 10 identified symptoms. Towards the end of life, difficulties with mobility, sleep disturbance, agitation and other neuropsychiatric symptoms, such as episodes of depression, decreased (decrescent pattern), while pain, feeding problems, breathing abnormalities, apathy and anxiety increased (crescent pattern). Courses of pain were documented in 17 % of the nursing records. In addition, 76 % of the residents had been visited on a daily basis by next of kin in their last 7 days, compared with only one third of residents previously. Furthermore, daily communication between healthcare professionals and next of kin tripled during this period.
  
  
  CONCLUSIONS
  The documented prevalence of a high and increasing level of pain towards the end of life, combined with the lack of documented courses of pain, shows potential for improvement in pain relief and pain identification for patients with dementia in their terminal phase. The increasing number of visits by next of kin and the increasingly intensive contact between healthcare professionals and next of kin in the last 7 days are a strong indicator that the end of life can be predicted relatively well by the involved participants and appropriate reactions follow.
authors.affiliation: Institute of Nursing, Zurich University of Applied Sciences (ZHAW), Technikumstr. 71, 8404, Winterthur, Switzerland, andrea.koppitz@zhaw.ch.
authors.forename: A
authors.initials: A
authors.lastname: Koppitz
authors.forename: G
authors.initials: G
authors.lastname: Bosshard
authors.forename: D H
authors.initials: DH
authors.lastname: Schuster
authors.forename: H
authors.initials: H
authors.lastname: Hediger
authors.forename: L
authors.initials: L
authors.lastname: Imhof
mesh_terms: D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D003704:Dementia / Q000175:diagnosis* / Q000401:mortality* / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010146:Pain / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D010166:Palliative Care / Q000523:psychology / Q000706:statistics & numerical data*; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D015996:Survival Rate; D013557:Switzerland / Q000453:epidemiology; D063189:Symptom Assessment / Q000706:statistics & numerical data; D013727:Terminal Care / Q000523:psychology / Q000706:statistics & numerical data*