title: End-of-life care during and after an acute hospitalization in older patients with cancer, end-stage organ failure, or frailty: A sub-analysis of a prospective cohort study.
abstract: BACKGROUND
  Many patients show deterioration in functioning and increased care needs in the last year of life. End-of-life care needs and health care utilization might differ between groups of acutely hospitalized older patients.
  
  
  OBJECTIVE
  To investigate differences in geriatric conditions, advance care planning, and health care utilization in patients with cancer, organ failure, or frailty, who died within 1 year after acute hospitalization.
  
  
  METHODS
  Prospective cohort study conducted between 2002 and 2008, with 1-year follow-up.
  
  
  METHODS
  University teaching hospital in the Netherlands.
  
  
  METHODS
  Aged ⩾65 years, acutely hospitalized for ⩾48 h, and died within 1 year after hospitalization. At admission, all patients received a systematic comprehensive geriatric assessment. Hospital records were searched for advance care planning information and health care utilization. Differences between patient groups were calculated.
  
  
  RESULTS
  In total, 306 patients died within 1 year after acute admission (35%) and were included; 151 with cancer, 98 with end-stage organ failure, and 57 frail older persons. At hospital admission, 72% of the frail group had delirium and/or severe pre-existing cognitive impairment. The frail and organ failure group had many pre-existing disabilities. Three months post-discharge, 75% of the frail and organ failure group had died, 45% of these patients had an advance care plan in their hospital records.
  
  
  CONCLUSIONS
  Patients with frailty and organ failure had highest rates of geriatric conditions at hospital admission and often had missing information on advance care planning in the hospital records. There is a need to better identify end-of-life needs for these groups.
authors.affiliation: Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Sanne
authors.initials: S
authors.lastname: Huijberts
authors.affiliation: Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Bianca M
authors.initials: BM
authors.lastname: Buurman
authors.affiliation: Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands University Medical Center Groningen, University of Groningen, Groningen, The Netherlands s.e.derooij@amc.uva.nl.
authors.forename: Sophia E
authors.initials: SE
authors.lastname: de Rooij
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology; D005260:Female; D016330:Frail Elderly; D006760:Hospitalization; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000628:therapy*; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D013727:Terminal Care
keywords: Advance care planning; end-of-life care; end-stage organ failure; health care utilization; hospitalization; palliative care