[The final week of life in an acute care hospital: review of 401 consecutive patients]. / Ultima semana de vida en un hospital de agudos: revisión de 401 pacientes consecutivos.

INTRODUCTION: because of population ageing and sociocultural changes related to death, increasing the numbers of patients are dying in hospitals. OBJECTIVES: to analyze patient characteristics and end-of-life care in the final week of life in patients dying in an acute-care hospital. MATERIAL AND METHODS: all patients older than 18 years old who died in the hospital over a 1-year period were analyzed. Patients dying in intensive care and emergency units were excluded. The following variables were evaluated: demographic data, main illness, cause of admission, comorbidity, terminal illness, medication, delay in beginning palliative sedation, use of devices, adverse events, and do not attempt resuscitation orders. RESULTS: a total of 401 patients (mean age: 78 +/- 11 years) with numerous comorbidities were evaluated. Of these, 348 patients (87%) were considered to be terminal. The reason for admission was related to the main disease in 207 patients (52%). Terminal sedation was applied in 311 patients (78%), and informed consent from the relatives was documented in 294 patients (73%). Intervention by on-call physician was required to control symptom aggravation in 214 patients (55%). Active medication was maintained in addition to sedation in 145 patients (36%). Complementary examinations were performed in 109 patients (40%), but did not modify prognosis. CONCLUSIONS: reasonable therapeutics objectives relating to the patient's situation and guidelines to improve quality of life at the end of life should be established.

Última semana de vida en un hospital de agudos: revisión de 401 pacientes consecutivos / The final week of life in an acute care hospital: review of 401 consecutive patients

Introducción: el envejecimiento y el cambio sociocultural frente a la muerte hacen que cada vez sea mayor el número de personas que fallecen en los hospitales. Objetivos: analizar aspectos relacionados con la última semana de vida de los pacientes que fallecen en un hospital de agudos. Material y métodos: se evaluó a los pacientes mayores de 18 años que fallecieron en el hospital durante un año, excluyendo los fallecidos en cuidados intensivos y en urgencias. Se analizaron: datos demográficos, enfermedad principal, motivo de ingreso, enfermedad terminal, comorbilidad, medicación, inicio de sedación, instrumentaciones, incidencias y órdenes de no iniciar reanimación cardiopulmonar. Resultados: se evaluó a 401 pacientes, con una edad media ± desviación estándar de 78 ± 11 años y elevada comorbilidad. Eran terminales 348 (87%) pacientes y en 207 (52%) pacientes el motivo de ingreso estaba relacionado con su enfermedad principal. La sedación terminal fue necesaria en 311 (78%) pacientes y constaba en la historia clínica que se había consensuado con sus familiares en 294 (73%) pacientes. Para el control de síntomas, 214 (55%) pacientes requirieron la intervención del médico de guardia. En 145 (36%) pacientes se mantuvo la medicación activa además de la sedativa, y en 109 (40%) pacientes se realizaron exploraciones complementarias sin que éstas modificaran el pronóstico. Conclusiones: es preciso establecer objetivos terapéuticos razonables en relación con la situación del paciente y protocolizar las intervenciones para mejorar la calidad de vida al final de la vida

Introduction: because of population ageing and sociocultural changes related to death, increasing the numbers of patients are dying in hospitals. Objectives: to analyze patient characteristics and end-of-life care in the final week of life in patients dying in an acute-care hospital. Material and methods: all patients older than 18 years old who died in the hospital over a 1-year period were analyzed. Patients dying in intensive care and emergency units were excluded. The following variables were evaluated: demographic data, main illness, cause of admission, comorbidity, terminal illness, medication, delay in beginning palliative sedation, use of devices, adverse events, and ¿do not attempt resuscitation orders¿. Results: a total of 401 patients (mean age: 78 ± 11 years) with numerous comorbidities were evaluated. Of these, 348 patients (87%) were considered to be terminal. The reason for admission was related to the main disease in 207 patients (52%). Terminal sedation was applied in 311 patients (78%), and informed consent from the relatives was documented in 294 patients (73%). Intervention by on-call physician was required to control symptom aggravation in 214 patients (55%). Active medication was maintained in addition to sedation in 145 patients (36%). Complementary examinations were performed in 109 patients (40%), but did not modify prognosis. Conclusions: reasonable therapeutics objectives relating to the patient's situation and guidelines to improve quality of life at the end of life should be established (AU)