End-of-life programme for older patients in a geriatric step-down hospital

Abstract

Objectives. To evaluate the end-of-life (EOL) programme in a geriatric step-down hospital in enhancing dignified death. Methods. Medical records of patients aged ≥65 years who were admitted to the EOL programme between 24 August 2015 and 31 October 2017 were retrospectively reviewed. The Quality of Dying and Death (QODD) questionnaire was used to assess family member satisfaction of the programme. Results. 235 patients (mean age, 87.9 years) were reviewed. Their principal diagnoses were advanced dementia (n=118, 50.2%), active cancers (n=65, 27.7%), organ failure (n=31, 13.2%), stroke (n=11, 4.7%), and neurodegenerative diseases (n=6, 2.6%). In the last 24 hours before death, 99.2% of patients were pain-free, not agitated, and without excessive secretion. Compared with pre-EOL programme, EOL programme significantly reduced the use of intravenous and ‘big gun’ antibiotics, blood product transfusion, physical restraints, blood tests, haemoglucostix monitoring, and cardiac monitoring (all p<0.001). The number of regular medications dropped from 4.8 to 2.6 per patient (p<0.001). Patients received prompt services from physiotherapists (88.9%), occupational therapists (87.2%), social workers (86.4%), and chaplains (69%). 90.6% of carers stayed with patients beyond visiting hours, and 87.7% were able to say goodbye to their dying relatives. All patients had ‘do not attempt cardiopulmonary resuscitation’ in place and were not resuscitated. 133 (56.6%) QODD questionnaires were returned, and the mean score was 8.5 out of 10. Conclusion. The EOL programme is useful to foster dignified death and comfort care among dying older patients in a geriatric step-down hospital.