[NOT ONLY FOR CANCER PATIENTS - PALLIATIVE CARE FOR NON-ONCOLOGIC PATIENTS AT THE END OF LIFE IN A GERIATRIC - INTERNAL MEDICINE DEPARTMENT].

AIMS

This article presents our ongoing experience in the care of palliative patients suffering from non-oncologic diseases.

BACKGROUND

Palliative care is an approach intended to improve quality of life in patients facing life-threatening illness. This approach entails early identification, thorough assessment and treatment of pain and suffering as well as establishing a goals-directed care plan in order to improve these patients' quality of life. While in oncology patients there is a steady increase in the awareness of the need for palliative care, in non-oncology patients there is a marked deficit regarding identification of patients needing palliative care, determination of goals of care and delivery of palliative care throughout the disease and at the end of life. Furthermore, there is a lack of appropriate platforms to deliver such care. In Israel, the majority of deaths occur in-hospital. Therefore, it makes sense to implement good palliative care platforms in hospitals, in order to meet the need for palliative care. In January 2018, we opened an inpatient palliative care unit within the Geriatric-Internal Medicine Department in the Tel Aviv Sourasky Medical Center.

METHODS

This is a retrospective study of all the patients who died in the Geriatric Internal Medicine Department, during the period 1.1.2018-31.7.2020.

RESULTS

A total of 2,335 patients were admitted to the ward during the period 1.1.2018-31.7.2020. Within this group, 371 (16%) died during hospitalization, 257 died from oncologic diseases, 8 died unexpectedly and 106 died from non-oncologic diseases. Patients who suffered from non-oncologic diseases were older, with a shorter length of stay (9.6 vs. 10.5 days) and were more likely to be bed-ridden. The most common cause of death was infection (48%), pneumonia being the most prevalent. Most end-of-life decisions were made during hospitalization, with the guidance of the next of kin.

CONCLUSIONS

Patients suffering from non-oncologic diseases represent a considerable number of palliative care patients. However, there is a marked deficit in the ability to recognize their palliative needs, prognostication and therefore, identifying the right platform to care for them. We have described such a platform in the Geriatric Internal ward.