Shortcuts August 2013

Dtsch Arztebl Int. 2013. 110(12):195-202

Dying with dementia: symptom burden, quality of care, and place of death

Pinzon LC, Claus M, Perrar KM, Zepf KI, Letzel S, Weber M.

This cross-sectional study contacted surviving relatives of 5000 randomly selected people who died in mid-2008 in a single German state. Relatives were asked by letter to participate in a questionnaire survey. Information was acquired for 310 people with dementia and 931 people without dementia. For people with dementia 42% died at home, 27% in a nursing home, 20% in a hospital ward, 6% in intensive care and 3% in a palliative care unit, with home and nursing home deaths were higher in patients with dementia compared to those without. A home death was preferred by 94.8% of patients and 77.5% of their relatives. People living with at least one relative were 4.7 times more likely to die at home. According to relatives, most patients suffered, two days before death: 95% with moderate to severe weakness, 94% with fatigue, 87% with disorientation/confusion, 86% with appetite loss, 61% with anxiety, 57% with dyspnoea, and 53% with pain. Weakness, fatigue, appetite loss and dyspnoea were not statistically different from the non-demented group. Pain and nausea were less frequent in the demented group and pressure sores and disorientation/confusion more frequent in patients with dementia. There were also greater problems with organization of care for patients with dementia. The relatives were critical of the quality of care on standard hospital wards, with a lack of availability of staff and poor emotional support. This study shows a need for more palliative care for patients with dementia and their families.

 DOI: 10.3238/arztebl.2013.0195

Prog Palliat Care. 2013 Jul;21(3):140-145

Co-morbidities of persons dying of Parkinson’s disease

Lethbridge L, Johnston GM, Turnbull G.

Using death certificate data from 1998 to 2005 (N = 63,431) from the Nova Scotia Vital Statistics death certificate database, patients who died of Parkinson’s disease (PD) were compared with the general population and an age-sex-matched sample without PD. Of them 900 (1.4%) patients had PD mentioned on the death certificate, in 418 (46.4%) of these it was the underlying cause of death. For patients who had PD, 54.8% were 80–89 years of age, compared with 32.4% for all people who died. Patients with PD had a mean age of death of 82.0 years old compared to 74.9 years old for all people who died. Just over 70% of those with PD had three or more causes of death listed compared with just over half of all and age-sex-matched decedents. The overall mean number of causes was 3.4 for those with PD, 2.8 for all deaths, and 2.9 for the matched sample. Cancer was the most common cause of death in the population and matched sample but fifth for those with PD. Compared to all deaths, occurred 2.5 times more frequently in patients with PD and pneumonia 1.8 times more. Dementia was 1.4 and pneumonia 1.2 times more frequent when compared to the age-sex-matched sample. In view of age and comorbidity differences, the authors suggest that this data should be used to assist in the planning of palliative care in PD.

doi:  10.1179/1743291X12Y.0000000037

By Jason Boland