Emergencies at end-of-life for older people in nursing homes

Purpose. - The aim of this study was to describe and understand the magnitude and the variability of end-of-life emergency situations in nursing homes and to identify the care practices and organization implemented to deal with these.Method. - A cross-sectional survey was conducted on a sample of Breton nursing homes. Residents in an end-of-life situation on the day of the survey and residents who had died in the last 3 months were included.Results. - In total, 602 residents were included in 125 nursing homes and 41 end-of-life emergency situations were identified, for which a transfer to hospital was decided in 41.5%. Hospitalization was considered avoidable by the facility coordinating professional in 28.6% . The mobile palliative care teams were identified as facility resources in 83.9% but the at-home hospitalization teams in only 62.9%. Only 12.6% of the nursing homes identified a referral nurse for palliative care and the palliative care training of professionals was very heterogeneous.Conclusions. - Some hospital transfers appear to be avoidable in an end-of-life emergency context. The care organizations likely to encourage older people to stay in nursing homes are heterogeneous. A better knowledge of the specialized facilities that can help with residents, the implementation of an institutional reflection on end-of-life support and the early development of a life project shared by the resident, relatives and health professionals, appear to improve the ability to manage the residents in nursing homes at the end of life.(c) 2021 Elsevier Masson SAS. All rights reserved.