Abstract
Background: Palliative care needs in older persons are often not recognized timely, resulting in inappropriate care and avoidable care transitions in the last phase of life. It is expected that palliative care needs are also present in persons admitted for geriatric rehabilitation (GR), e.g., after a cerebrovascular incident or hip fracture. However, the prevalence of these needs is unclear. Furthermore, it is uncertain what factors healthcare professionals consider when assessing persons with potential palliative care needs.
Approach: The study examined: 1) the prevalence of persons with potential palliative care needs in the GR, 2) the incidence of death within six months and one year, and 3) the factors that healthcare professionals consider when assessing whether individuals are in need of palliative care. Two GR departments participated in this prospective observational study between February and August 2024. At baseline, data regarding sociodemographic characteristics, vulnerability, comorbidities, and activities of daily living (ADL) were collected. Involved healthcare professionals answered the double surprise question (SQ): ‘Would you be surprised if this person died within 12 months?’ (SQ1), ‘Would you be surprised if this person was still alive in twelve months?’ (SQ2), and the factors on which they based their answers. Healthcare professionals’ background (e.g., age, function and years of work experience) were collected, and agreements and differences in answering the SQs were analysed.
Results: In total, 196 persons have been included; 65% were female, and the average age was 79 years (SD 11). Persons were primarily admitted because of pneumonia, COPD exacerbation, heart failure, or hip fracture. A total of 759 SQs were completed by 79 healthcare professionals (30% by nurses and 22% by physiotherapists). In total, 61.7% of persons were assessed as having potential palliative care needs (51% in SQ1 and 18% in SQ2) by ≥ 1 healthcare professional, primarily based on age (67%), medical condition (65%), ADL functioning (57%), and comorbidities (43%). Preliminary results show that 12/80 (15%) persons died within six months after GR admission. In the coming months, follow-up on six and twelve months will be completed.
Implications: Our preliminary results show a high prevalence of potential palliative care needs, as assessed by the interdisciplinary GR team, and mortality within six months. The recognition of these persons is essential to initiate timely advance care planning. Currently, a new transmural care pathway for older persons is developed in a region of the Netherlands, aiming to provide coordinated patient-centred palliative care in close collaboration and shared responsibility among involved general and specialised healthcare professionals across care settings. Our results will contribute to insights on the potential of this pathway for persons, admitted to the GR, with potential palliative care needs.