Dying in the hospital from an end-stage non-oncologic disease:: a decision making analysis

BACKGROUND AND OBJECTIVE: The aim of the study was to evaluate palliative decision-making in non- oncological patients who died in an acute care hospital. PATIENTS AND METHOD: 293 patients > 64 years old were analyzed. These patients suffered from dementia (46%), end-stage congestive heart failure (31%) and end-stage chronic obstructive pulmonary disease (23%). We evaluated written information about: do not resuscitate (DNR) orders, graduation of therapeutic decisions, information provided to relatives about prognosis, total withdrawal of other drug therapy and provision of terminal care. RESULTS: DNR orders were specified in 37% of cases, graduation of therapeutic decisions in 18% and knowledge of the prognosis by relatives in 57%. Drug withdrawal was carried out in 56% and palliative care in 65% patients. CONCLUSIONS: Identification and provision of palliative care, in an acute care hospital, of elderly patients at their last admission prior to death because of non-ontological end-stage diseases must be improved.