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Terminal care in older patients in hospital : development of a quality indicator set and its first application in a retrospective comparison of patients treated in acute geriatric unit and a palliative care unit of a Belgian university hospital

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Abstract
Background: Care at the end-of-life of geriatric inpatients is of increasing importance. Nevertheless, limited research has been conducted on this subject so far. Objectives: To compose a set of quality indicators (QIs) which measure the quality of terminal care for geriatric inpatients and to compare the quality of end-of-life care between the Acute Geriatric Unit (AGU) and the Palliative Care Unit (PCU). Design: Retrospective case study. Setting: Belgian university hospital. Participants: Patients >75 years, who died an expected death between January 1st 2009 and December 31st 2010 at the AGU or the PCU. Measurements: QIs collected through systematic literature search and the Delphi method. Results: A set of 17 QIs was composed. At the AGU, 58 patients were included (QI score generally varying between 0 and 70%) and at the PCU 59 (QI score generally varying between 50 and 100%). The PCU scored significantly higher for 5 of the 17 QIs: pain screening, oral care and anxiety screening (all p < .001), prescription of rescue medication (p < .01), and pain treatment (p < .05). Both units scored low on delirium screening, spiritual care, and involvement of the general practitioner (GP) in care planning. Conclusion: In-hospital care for the dying geriatric patient could be optimized further. Both departments should pay more attention to delirium screening, spiritual care, and the involvement of the GP in the care planning. At the AGU it is recommended that items regarding pain screening and treatment, oral care, and anxiety screening should routinely be included in the dying patients’ records.
Keywords
Quality indicators, Palliative care, Geriatric patient, Elderly, End-of-life care, Quality of care

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Chicago
Cools, Annelies, Delphine Vaneechoutte, Nele Van Den Noortgate, Karen Versluys, Martine De Laat, Mirko Petrovic, and Ruth Piers. 2015. “Terminal Care in Older Patients in Hospital : Development of a Quality Indicator Set and Its First Application in a Retrospective Comparison of Patients Treated in Acute Geriatric Unit and a Palliative Care Unit of a Belgian University Hospital.” Journal of Geriatric Medicine and Gerontology 1 (1).
APA
Cools, Annelies, Vaneechoutte, D., Van Den Noortgate, N., Versluys, K., De Laat, M., Petrovic, M., & Piers, R. (2015). Terminal care in older patients in hospital : development of a quality indicator set and its first application in a retrospective comparison of patients treated in acute geriatric unit and a palliative care unit of a Belgian university hospital. JOURNAL OF GERIATRIC MEDICINE AND GERONTOLOGY, 1(1).
Vancouver
1.
Cools A, Vaneechoutte D, Van Den Noortgate N, Versluys K, De Laat M, Petrovic M, et al. Terminal care in older patients in hospital : development of a quality indicator set and its first application in a retrospective comparison of patients treated in acute geriatric unit and a palliative care unit of a Belgian university hospital. JOURNAL OF GERIATRIC MEDICINE AND GERONTOLOGY. 2015;1(1).
MLA
Cools, Annelies, Delphine Vaneechoutte, Nele Van Den Noortgate, et al. “Terminal Care in Older Patients in Hospital : Development of a Quality Indicator Set and Its First Application in a Retrospective Comparison of Patients Treated in Acute Geriatric Unit and a Palliative Care Unit of a Belgian University Hospital.” JOURNAL OF GERIATRIC MEDICINE AND GERONTOLOGY 1.1 (2015): n. pag. Print.
@article{6928757,
  abstract     = {Background: Care at the end-of-life of geriatric inpatients is of increasing importance. Nevertheless, limited research has been conducted on this subject so far.
Objectives: To compose a set of quality indicators (QIs) which measure the quality of terminal care for geriatric inpatients and to compare the quality of end-of-life care between the Acute Geriatric Unit (AGU) and the Palliative Care Unit (PCU).
Design: Retrospective case study.
Setting: Belgian university hospital.
Participants: Patients {\textrangle}75 years, who died an expected death between January 1st 2009 and December 31st 2010 at the AGU or the PCU.
Measurements: QIs collected through systematic literature search and the Delphi method.
Results: A set of 17 QIs was composed. At the AGU, 58 patients were included (QI score generally varying between 0 and 70\%) and at the PCU 59 (QI score generally varying between 50 and 100\%). The PCU scored significantly higher for 5 of the 17 QIs: pain screening, oral care and anxiety screening (all p {\textlangle} .001), prescription of rescue medication (p {\textlangle} .01), and pain treatment (p {\textlangle} .05). Both units scored low on delirium screening, spiritual care, and involvement of the general practitioner (GP) in care planning.
Conclusion: In-hospital care for the dying geriatric patient could be optimized further. Both departments should pay more attention to delirium screening, spiritual care, and the involvement of the GP in the care planning. At the AGU it is recommended that items regarding pain screening and treatment, oral care, and anxiety screening should routinely be included in the dying patients{\textquoteright} records.},
  articleno    = {002},
  author       = {Cools, Annelies and Vaneechoutte, Delphine and Van Den Noortgate, Nele and Versluys, Karen and De Laat, Martine and Petrovic, Mirko and Piers, Ruth},
  issn         = {2469-5858},
  journal      = {JOURNAL OF GERIATRIC MEDICINE AND GERONTOLOGY},
  language     = {eng},
  number       = {1},
  pages        = {5},
  title        = {Terminal care in older patients in hospital : development of a quality indicator set and its first application in a retrospective comparison of patients treated in acute geriatric unit and a palliative care unit of a Belgian university hospital},
  url          = {http://clinmedjournals.org/articles/jgmg/journal-of-geriatric-medicine-and-gerontology-jgmg-1-002.pdf},
  volume       = {1},
  year         = {2015},
}