Clinical and laboratory characteristics associated with referral of hospitalized elderly to palliative care

Abstract

ObjectiveTo investigate clinical and laboratory characteristics associated with referral of acutely ill older adults to exclusive palliative care.MethodsA retrospective cohort study based on 572 admissions of acutely ill patients aged 60 years or over to a university hospital located in São Paulo, Brazil, from 2009 to 2013. The primary outcome was the clinical indication for exclusive palliative care. Comprehensive geriatric assessments were used to measure target predictors, such as sociodemographic, clinical, cognitive, functional and laboratory data. Stepwise logistic regression was used to identify independent predictors of palliative care.ResultsExclusive palliative care was indicated in 152 (27%) cases. In the palliative care group, in-hospital mortality and 12 month cumulative mortality amounted to 50% and 66%, respectively. Major conditions prompting referral to palliative care were advanced dementia (45%), cancer (38%), congestive heart failure (25%), stage IV and V renal dysfunction (24%), chronic obstructive pulmonary disease (8%) and cirrhosis (4%). Major complications observed in the palliative care group included delirium (p<0.001), infections (p<0.001) and pressure ulcers (p<0.001). Following multivariate analysis, male sex (OR=2.12; 95%CI: 1.32-3.40), cancer (OR=7.36; 95%CI: 4.26-13.03), advanced dementia (OR=12.6; 95%CI: 7.5-21.2), and albumin levels (OR=0.25; 95%CI: 0.17-0.38) were identified as independent predictors of referral to exclusive palliative care.ConclusionAdvanced dementia and cancer were the major clinical conditions associated with referral of hospitalized older adults to exclusive palliative care. High short-term mortality suggests prognosis should be better assessed and discussed with patients and families in primary care settings.

Palliative care in Hospitalized Middle-Aged and Older Adults With COVID-19

“…In a pre-pandemic Brazilian cohort of 572 medical admissions of adults over the age of 60 years carried out in hospital 2, Arcanjo et al found that male sex, cancer, advanced dementia, and low albumin levels were independently associated with palliative care referral( 13 ). Conversely, we have examined patients aged 50 years or older, all admitted for COVID-19, and have identified additional predictors of palliative care including frailty, which has been recently associated with worse prognosis of COVID-19 ( 14 ).…”

“…In our study, we opted to capture clinical information that would most likely identify patients in palliative care. Previous studies have used similar strategies in the past( 13 , 21 ). Second, the two participating centers are traditional public teaching hospitals in Sao Paulo with established palliative care groups.…”

Patologias dos pacientes acompanhados pelo serviço de Cuidados Paliativos de um hospital universitário

“…Embora um em cada quatro idosos gravemente enfermos internados em alas geriátricas seja encaminhado para cuidados paliativos, não há um consenso a melhor forma de se avaliar e comunicar o prognóstico em populações geriátricas. O estabelecimento de melhores diretrizes clínicas pode contribuir para a identificação precoce de pacientes hospitalizados, que poderiam se beneficiar de cuidados paliativos, além de fornecer informações relevantes a pacientes e cuidadores envolvidos no processo de tomada de decisão (Arcanjo, et al, 2018).…”

Accuracy of Survival Prediction Instruments in Older Patients Undergoing Home-Based Palliative Care in Curitiba, Brazil

“…As doenças crônicas mais frequentes em serviços de cuidados paliativos são demência avançada, câncer e doenças cardíacas e circulatórias. 4,5 Apesar de existirem estudos que testam os escores prognósticos em ambientes não hospitalares e em pacientes não exclusivamente oncológicos, 6,7 eles normalmente focam em pacientes oncológicos e em ambiente hospitalar. 8,9 Grande parte desses trabalhos é realizada em outros países, gerando a necessidade de estudos nacionais com população heterogênea e em ambientes diferentes, como o Serviço de Atenção Domiciliar (SAD).…”