title: End-of-Life Care and Quality of Dying in 23 Acute Geriatric Hospital Wards in Flanders, Belgium.
abstract: To describe the nursing and medical interventions performed in the last 48 hours of life and the quality of dying of patients dying in acute geriatric hospital wards.
  
  
  
  Cross-sectional descriptive study between October 1, 2012 and September 30, 2013. Twenty-three acute geriatric wards in 13 hospitals in Flanders, Belgium. Patients hospitalized for more than 48 hours before dying in the participating wards. Structured after-death questionnaires, filled out by the nurse, the physician, and the family carer most involved in end-of-life care. Main outcome measures were several nursing and medical interventions reported to be performed in the last 48 hours of life and the quality of dying.
  
  
  
  Of 993 patients, we included 338 (mean age 85.7 years; 173 women). Almost 58% had dementia and nearly half were unable to communicate in the last 48 hours of their life. The most frequently continued or started nursing and medical interventions in the last 48 hours of life were measuring temperature (91.6%), repositioning (83.3%), washing (89.5%), oxygen therapy (49.7%), and intravenous fluids and nutrition (30%). Shortness of breath, lack of serenity, lack of peace, and lack of calm were symptoms reported most frequently by nurses and family carers.
  
  
  
  Many nursing and medical interventions are continued or started in the last hours of a patient's life, which may not always be in their best interests. Furthermore, patients dying in acute geriatric wards are often affected by several symptoms.
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Verhofstede
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium. Electronic address: tinne.smets@vub.ac.be.
authors.forename: Tinne
authors.initials: T
authors.lastname: Smets
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.
authors.forename: Kim
authors.initials: K
authors.lastname: Eecloo
authors.affiliation: Palliative Care Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Costantini
authors.affiliation: Department of Geriatrics, Ghent University Hospital, Ghent, Belgium.
authors.forename: Nele
authors.initials: N
authors.lastname: Van Den Noortgate
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium; Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D017028:Caregivers; D003142:Communication; D003430:Cross-Sectional Studies; D003704:Dementia / Q000401:mortality / Q000628:therapy; D005190:Family; D005260:Female; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D010820:Physicians; D011787:Quality of Health Care; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013727:Terminal Care
keywords: Quality of dying; end-of-life care; hospital; older people