Quality of end-of-life care for dementia patients during acute hospital admission: a retrospective study in Ireland

Objectives: To examine the quality of end-of-life care received by patients with and without dementia on acute medical wards during their final hospitalization. Methods: A retrospective clinical case note review of patients aged over 65 who had died on acute medical wards within a 6-month period in a general hospital in Dublin was conducted. Seventy-five multidisciplinary clinical notes were available for scrutiny in order to identify cognitive status, measure the frequency of invasive procedures undertaken and examine the quality of palliative care as benchmarked with the Liverpool Care Pathway for the Dying Patient (LCP) program. Comparison between patients with and without dementia was made. Results: Eighteen (24.0%) subjects had dementia, 32 (42.7%) subjects were described as "cognitively intact" and 25 subjects did not have reference to cognitive status. Of the 50 patients with known cognitive status, 27 (54.0%) had had a Mini Mental State Examination (MMSE) conducted (10 dementia vs. 17 nondementia). Patients were equally subjected to invasive interventions regardless of their cognitive status. However, dementia patients were significantly less likely to be referred to palliative care interventions (P=.007), to be prescribed palliative drugs (P=.017) and to have carers involved in decision making (P=.006). Conclusion: Individuals with dementia may be receiving different end-of-life care from those without. The effective delivery of robust multidisciplinary frameworks for the palliation of symptoms of hospitalized dementia patients remains an important clinical goal. (C) 2010 Elsevier Inc. All rights reserved.