Object: The object of this study is to get more insight on the incidence of nursing home patients requiring palliative terminal care and what disorders and symptoms accompany the terminal phase in these patients.
Methods: Observational cohort study in 16 representative Dutch nursing homes all over the Netherlands. All long-term care patients with a life expectancy, as judged by their nursing home physician, of 6 weeks or less (n=516) were enrolled in our study. Characteristics of patients, disorders and symptoms that caused directly the terminal phase and the underlying disease of the terminal phase, were examined.
Results: Per 100 beds, per year 33 nursing home residents entered a terminal phase and required palliative care. In only 12% of the patients cancer was the underlying disease of the terminal state. The terminal state was marked with low fluid and food intake, general weakness and respiratory problems/ dyspnea. Direct causes for this condition were diseases of the respiratory system, mostly pneumonia and general disorders e.g. cachexia, malaise. 82.9% of the patients included died within seven days.
Conclusions: Once diagnosed as terminal, little time is left for providing palliative care to the - mainly-non-cancer patients in a long-term care setting. This raises the question, how within this very limited timeframe palliative terminal care can be implemented adequately.