In-hospital end-of-life care in the old: a retrospective study of intensive care unit use and do-not-resuscitate forms in patients deceased in a Belgian university hospital.

OBJECTIVES: To explore the quality of in-hospital end-of-life care in adult patients with special attention to those 75 years and older and to make a comparison with the situation 10 years ago. METHODS: Data were retrospectively collected on adult patients who deceased at Ghent University Hospital between September 2018 and December 2019. The main outcome measures were 'ICU use' and 'presence of DNR forms on non-ICU units' in the final hospitalization. In order to identify possible risk factors for ICU use, logistic regression was performed. RESULTS: In total, 762 people died, of whom 35% were 75 or older. Just as 10 years ago, one-third (31%) died in the ICU versus 49% of those younger than 75 years (p < 0.001). Of people ≥75 years, 38%, compared to 42% 10 years ago, received an ICU treatment during their final hospitalization. The median length of an ICU stay was 4 versus 3 days 10 years ago. After adjusting for gender, comorbidities and the Charlson Comorbidity Index, factors associated with less ICU use were higher age, active malignancy and dementia (OR 0.838, 0.116 and 0.098 respectively). Seventy-nine percent of older patients on non-ICU wards died with a DNR form (versus 87% 10 years ago). CONCLUSION: Although there was an increase in the presence of DNR forms in the final hospitalization, no significant differences were seen in actual ICU use compared to 10 years ago. Factors associated with less ICU use were higher age, active malignancy and dementia.

Influence of physical activity on hydration state in children with obesity before and after a weight loss program.

Objective: Evaluate the effect of a 1-year standardized residential slimming program on exercise-induced dehydration in children with obesity. Method: At the start (T1) and end (T2) of the program, urine samples, weight, blood pressure and pulse were collected before (TR) and after a Cooper test (TE). Urinary samples were analyzed for volume, Na (UNa), Cl, K (UK), urea, creatinine (Ucreat), protein and osmolality (Uosm). Results: All 66 children (15 ± 1 years) starting the program were included after informed consent (28 stopped prematurely). The Cooper test induced a significant weight loss at each test moment (p < 0.01). The resting UK/(UNa + UK) % increased significantly from 40 (±11) at T1 to 50% (±11) at T2. Only in normal weight patients, exercise induced a significant increase in UK/(UNa + UK) % (T2R: 49 ± 11; T2E: 56 ± 12) (p < 0.01) as well as an increase in UNa/Ucreat mmol/mg (T2R: 0.12 ± 0.07; T2E: 0.1 ± 0.05) (p < 0.05). Conclusion: The significant weight loss after exercise indicated significant dehydration. In patients with obesity, no aldosterone effect measured by UK/(UNa + UK)% was observed in contrast to the normal body mass index patients after the program.