Old and given up for dying? -Palliative Care in Nursing Homes Bettina S. Husebø, Stein Husebø. Bergen Red Cross Nursing Home/West Norwegian Center for Palliative Care, University of Bergen Object of study: Evaluation of Palliative Care in Norway’s largest nursing home (208 beds). Since 1998 a national project: Palliative Care for the Old-is established there, providing an educational program for the nursing home staff.
Method: In a retrospective study we investigated: A. Level of preparation and communication before death, B. Use of the most common drugs for palliative symptom relief in the final 24 hours In a limited time period after all deaths we investigated: the medical journal, ward charts and nurses documentation. Three groups were compared: 1. Long term ward patients before start of the palliative care project (n=107) 2. Long term ward patients after start of the palliative care project (n=179) 3. Patients at the palliative unit (n=148).
Results: A. Before start of the project only in 32% of all deaths notes about preparation and communication were identified. 20% of the relatives were present when the patient died. After the project started 85% of patients or relatives were prepared. 54% were present. At the palliative care unit the figure was 100% prepared and 91% present. B. Before start of the project 9% of the patients received opioids in their last 24 hours. After start of the project 83% on long-term wards and 91% at the palliative care unite received opioids. None of the patients received an anticholinergic drug before the project, compared with 37% after, and 58% at the palliative care unit. The figures were similar regarding antiemetics and benzodiazepines. The Comparison of the groups was significant (p<0.001).
Conclusion: 1. Dying patients in nursing homes do not receive proper palliative care. 2. Focus on palliative care education for nursing home staff can establish excellent palliative care in nursing homes.