title: End-of-life care for people dying with dementia in general practice in Belgium, Italy and Spain: A cross-sectional, retrospective study.
abstract: OBJECTIVE
  To describe and compare end-of-life care for people with mild or severe dementia in general practice in Belgium, Italy and Spain, in terms of place of care, place of death, treatment aims, use of specialized palliative care and communication with general practitioners (GPs).
  
  
  METHODS
  Cross-sectional retrospective survey was carried out of nationwide networks of GPs in Belgium, Italy and Spain, including patients who died aged 65 years or older in 2009-2011 and were judged by the GP to have had dementia (n = 1623).
  
  
  RESULTS
  GPs reported a higher proportion of older people with severe dementia in Belgium (55%) than in Spain (46 %) and Italy (45 %), and a higher proportion of patients living in care homes (57% vs 18% and 13%, respectively). A palliative treatment aim was common in the last 3 months of life in all three countries. Specialized palliative care services were provided in 14% (Italy, severe dementia) to 38% (Belgium, severe dementia) of cases. Communication between GP and patient about illness-related topics occurred in between 50% (Italy) and 72% (Belgium) of cases of mild dementia, and 10% (Italy) to 32% (Belgium) of cases of severe dementia. Patient preferences for end-of-life care were known in a minority of cases. Few people (13-15 %) were transferred between care settings in the last week of life.
  
  
  CONCLUSIONS
  Although overall treatment aims at the end of life are often aligned with a palliative care approach and transfer rates are low, there is room for improvement in end-of-life care for people with dementia in all countries studied, especially regarding early patient-GP communication. Geriatr Gerontol Int 2017; 17: 1667-1676.
authors.affiliation: Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Yolanda W H
authors.initials: YWH
authors.lastname: Penders
authors.affiliation: Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Gwenda
authors.initials: G
authors.lastname: Albers
authors.affiliation: Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.|Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.affiliation: Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute, Florence, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Miccinesi
authors.affiliation: Public Health Directorate, Regional Ministry of Health (Dirección General de Salud Pública, Consellería de Sanidad), Castile and Leon, Valladolid, Spain.
authors.forename: Tomás
authors.initials: T
authors.lastname: Vega Alonso
authors.affiliation: Public Health Directorate, Regional Ministry of Health (Dirección General de Salud Pública, Conselleria de Sanitat), Comunitat Valenciana, Valencia, Spain.
authors.forename: Maite
authors.initials: M
authors.lastname: Miralles
authors.affiliation: Scientific Institute of Public Health (Wetenschappelijk Instituut Volksgezondheid, Institut Scientifique de Santé Publique), Unit of Health Services Research, Brussels, Belgium.
authors.forename: Sarah
authors.initials: S
authors.lastname: Moreels
authors.affiliation: Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.
authors.forename: Lieve
authors.initials: L
authors.lastname: Van den Block
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D003142:Communication; D003430:Cross-Sectional Studies; D003704:Dementia / Q000401:mortality / Q000523:psychology* / Q000628:therapy*; D005260:Female; D058006:General Practice; D006801:Humans; D007558:Italy; D008297:Male; D010166:Palliative Care; D057240:Patient Preference; D012189:Retrospective Studies; D013030:Spain; D013727:Terminal Care
keywords: dementia; end-of-life; international perspectives; primary care; public health