Palliative care and advanced dementia: Trajectory of hospitalized elderly people in their last 48 hours of life

Abstract

This study aimed to analyze the last 48 hours of life of hospitalized elderly with advanced dementia and the profile of care over the 5 years analyzed. This is a retrospective cross-sectional study, through the analysis of electronic medical records of patients participating in the study, who died between January 1, 2013 and December 31, 2017. 328 medical records were analyzed in the defined period and 97 met the inclusion criteria. Ninety-three patients (95.9%) had records of advance directives of their wills, 73.2% were female, with a mean age of 88.7 years, 52.6% of deaths occurred in an apartment or infirmary, in the latter 48h of life, 64.9% were on an enteral diet, 28.9% were breathing by mechanical ventilation, 51% were using antibiotics, and 86.6% were prescribed fixed analgesia; however, 19% had a record of uncontrolled pain. Over the 5 years of observation, there were changes in the following aspects: Reduction of deaths in the intensive care unit (60% vs. 36.4%), decrease in the use of tube feeding (87% vs. 32%), in the use of mechanical ventilation (53% vs. 18%); the use of central venous catheter (47% vs. 27%); the use of permanent urinary catheter (27% vs. 5%), and the presence of pressure injuries (87% vs. 45%). It is concluded that in the 5 years of analysis a palliative trend in care was characterized by the reduction of procedures considered invasive, in the last 48 hours of life, in patients with advanced dementia.