CONTEXT: Hospice utilization is an end-of-life quality indicator. The Deep South has known disparities in palliative care that may affect hospice utilization.
OBJECTIVES: To evaluate the association among Deep South patient and hospital characteristics and hospice utilization.
METHODS: This retrospective cohort study evaluated patient and hospital characteristics associated with hospice among Medicare cancer decedents aged >=65 in 12 southeastern cancer centers between 2012-2015. We examined patient-level characteristics (age, race, gender, cancer type, and received patient navigation) and hospital-level characteristics (board-certified palliative physician, inpatient palliative care beds, and hospice ownership). Outcomes included hospice (within 90 vs 3 days of death). Relative risks (RR) and 95% confidence intervals evaluated the association between patient- and hospital-level characteristics and hospice outcomes using generalized log-linear models with Poisson distribution and robust variance estimates.
RESULTS: Of 12,725 cancer decedents, 4,142 (33%) did not utilize hospice. "No hospice" was associated with non-white (RR 1.24, 95% CI 1.17, 1.32) and non-navigated patients (RR 1.17, 95% CI 1.10, 1.25), and those at a hospital with inpatient palliative care beds (RR 1.15, 95% CI 1.10, 1.21). "Late hospice" (20%; n=1,458) was associated with being male (RR 1.31, 95% CI 1.19, 1.44) and seen at a hospital without inpatient palliative care beds (RR 0.82, 95% CI 0.75, 0.90).
CONCLUSION: Hospice utilization differed by patient and hospital characteristics. Patients who were non-white, and non-navigated; and, hospitals with inpatient palliative care beds were associated with no hospice. Research should focus on ways to improve hospice utilization in Deep South older cancer patients.
Les mots "soins palliatifs" génèrent de nombreuses émotions pour le patient à qui le diagnostic est posé. Quand il n’y a plus rien à faire, tout reste à construire… Tout reste à "écrire", à "dire", à "vivre". L’accompagnement en soins palliatifs prend sens lorsqu’il s’inscrit dans une dynamique pluridisciplinaire. La musicothérapie vient donc prendre place dans ce travail d’équipe. Après avoir rencontré le patient lors d’un bilan psychomusical, le musicothérapeute pourra donc proposer un accompagnement personnalisé et adapté aux besoins et aux possibilités de celui-ci. Dans cet article, nous avons fait le choix de vous présenter deux techniques de musicothérapie réceptive, que nous développons dans nos pratiques cliniques en pédiatrie et en gériatrie.
Le consentement est une notion présente au cœur de notre pratique soignante. Comment faire lorsque la personne soignée est atteinte de troubles cognitifs altérant son jugement et son discernement ? Dans ce contexte, le consentement à l’entrée en institution convoque un questionnement éthique. Il est nécessaire d’interroger les pratiques et d’inscrire la personne âgée vulnérable dans une décision qui la concerne en premier lieu.
Background: Accurate pain assessment in elderly population is essential for pain management and nurses have a pivotal role. The 11-face Faces Pain Scale (FPS-11) is a well-established pain assessment measure that has not been validated in the Iranian elderly.
Aim: The aim was to study the property assessment of the Iranian version of FPS-11 (FPS-11-IR) among elderly outpatients with chronic pain.
Methods: This is a cross-sectional validation study that conducted in three outpatient clinics in Tehran, Iran, in 2017. Older people aged = 60 years (n = 217) with chronic knee pain due to degenerative joint disease were participated. The construct validity was examined by applying contrast constructs, and the face validity was determined by rank-ordering test. To assess concurrent validity, the Spearman's correlation coefficient was calculated between the scores of 11-point Numeric Rating Scale (NRS) and FPS-11-IR. Test-retest reliability was determined in 1-week interval.
Results: Most of elderly participants (72%) agreed that pain construct displays in faces of the FPS-11-IR and participants" agreement on face rank ordering were vary for each face, ranging from 80% to 100%. Spearman's correlation coefficient between FPS-11-IR and NRS scores was very strong (r = 0.91, P < 0.01). Intraclass correlation coefficient between test-retest scores was 0.96 that indicates excellent reliability.
Conclusions: The FPS-11-IR is a reliable and valid pain assessment scale to use in geriatric patients chronic pain.
Policy Points: We identified two overarching classifications of integrated geriatric and palliative care to maximize older people's quality of life at the end of life. Both are oriented to person-centered care, but with differing emphasis on either function or symptoms and concerns. Policymakers should both improve access to palliative care beyond just the last months of life and increase geriatric care provision to maintain and optimize function. This would ensure that continuity and coordination for potentially complex care needs across the continuum of late life would be maintained, where the demarcation of boundaries between healthy aging and healthy dying become increasingly blurred. Our findings highlight the urgent need for health system change to improve end-of-life care as part of universal health coverage. The use of health services should be informed by the likelihood of benefits and intended outcomes rather than on prognosis.
CONTEXT: In an era of unprecedented global aging, a key priority is to align health and social services for older populations in order to support the dual priorities of living well while adapting to a gradual decline in function. We aimed to provide a comprehensive synthesis of evidence regarding service delivery models that optimize the quality of life (QoL) for older people at the end of life across health, social, and welfare services worldwide.
METHODS: We conducted a rapid scoping review of systematic reviews. We searched MEDLINE, CINAHL, EMBASE, and CDSR databases from 2000 to 2017 for reviews reporting the effectiveness of service models aimed at optimizing QoL for older people, more than 50% of whom were older than 60 and in the last one or two years of life. We assessed the quality of these included reviews using AMSTAR and synthesized the findings narratively.
RESULTS: Of the 2,238 reviews identified, we included 72, with 20 reporting meta-analysis. Although all the World Health Organization (WHO) regions were represented, most of the reviews reported data from the Americas (52 of 72), Europe (46 of 72), and/or the Western Pacific (28 of 72). We identified two overarching classifications of service models but with different target outcomes: Integrated Geriatric Care, emphasizing physical function, and Integrated Palliative Care, focusing mainly on symptoms and concerns. Areas of synergy across the overarching classifications included person-centered care, education, and a multiprofessional workforce. The reviews assessed 117 separate outcomes. A meta-analysis demonstrated effectiveness for both classifications on QoL, including symptoms such as pain, depression, and psychological well-being. Economic analysis and its implications were poorly considered.
CONCLUSIONS: Despite their different target outcomes, those service models classified as Integrated Geriatric Care or Integrated Palliative Care were effective in improving QoL for older people nearing the end of life. Both approaches highlight the imperative for integrating services across the care continuum, with service involvement triggered by the patient's needs and likelihood of benefits. To inform the sustainability of health system change we encourage economic analyses that span health and social care and examine all sources of finance to understand contextual inequalities.
OBJECTIVE: Older people approaching the end of life are at high risk for adverse drug reactions. Approaching end of life should change the therapeutic aims, triggering a reduction in the number of drugs. The main aim of this study was to describe the preventive and symptomatic drug treatments prescribed to patients discharged from internal medicine and geriatric wards, with limited life expectancy. The secondary aim was to describe the potentially severe DDIs.
MATERIALS AND METHODS: We analyzed Registry of Polytherapies Societa Italiana di Medicina Interna (REPOSI), a network of internal medicine and geriatric wards, to describe the drug therapy of patients discharged with limited life expectancy.
RESULTS: The study sample comprised 55 patients discharged with limited life expectancy. Patients with at least one preventive medication that could be considered for de-prescription at end-of-life were significantly fewer from admission to discharge (30; 54.5% and 21; 38.2%, p = 0.02). ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, lipid-lowering drugs and clonidine were the most frequent potentially avoidable medications prescribed at discharge, followed by xanthine oxidase inhibitors and drugs to prevent fractures. Thirty-seven (67.3%) patients were also exposed to at least one potentially severe drug-drug interaction at discharge.
CONCLUSION: Hospital discharge is associated with small reductions in the use of commonly prescribed preventive medications in patients discharged with limited life expectancy. Cardiovascular drugs are the most frequent potentially avoidable preventive medications. A consensus framework, or shared criteria for potentially inappropriate medication in elderly patients with limited life expectancy could be useful to further improve drug prescription.
BACKGROUND: Polypharmacy may be particularly burdensome near the end of life, as patients "accumulate" medications to treat and prevent multiple diseases.
OBJECTIVE: To evaluate associations between polypharmacy, symptom burden, and quality of life (QOL) in patients with advanced, life-limiting illness (clinician-estimated, 1 month-1 year).
DESIGN: Secondary analysis of baseline data from a trial of statin discontinuation.
PARTICIPANTS: Adults with advanced, life-limiting illness.
MAIN MEASURES: Polypharmacy was assessed by summing the number of non-statin medications taken regularly or as needed. Symptom burden was assessed using the Edmonton Symptom Assessment Scale (range 0-90; higher scores indicating greater symptom burden) and QOL was assessed using the McGill QOL Questionnaire (range 0-10; higher scores indicating better QOL). Linear regression models assessed associations between polypharmacy, symptom burden, and QOL.
KEY RESULTS: Among 372 participants, 47% were age 75 or older and 35% were enrolled in hospice. The mean symptom score was 27.0 (standard deviation (SD) 16.1) and the mean QOL score was 7.0 (SD 1.3). The average number of non-statin medications was 11.6 (SD 5.0); one-third of participants took = 14 medications. In adjusted models, higher polypharmacy was associated with higher symptom burden (coefficient 0.81; p < .001) and lower QOL (coefficient - .06; p = .001). Adjusting for symptom burden weakened the association between polypharmacy and QOL (coefficient - .03; p = .045) without a significant interaction, suggesting that worse quality of life associated with polypharmacy may be related to medication-associated symptoms.
CONCLUSIONS: Among adults with advanced illness, taking more medications is associated with higher symptom burden and lower QOL. Attention to medication-related symptoms and shared decision-making regarding deprescribing are warranted in this setting.
NIH TRIAL REGISTRY NUMBER: ClinicalTrials.gov Identifier for Parent Study - NCT01415934.
OBJECTIVES: To describe the use of acute resuscitation plans (ARPs) among patients on a subacute geriatric ward and to identify factors associated with use of ARPs in these patients.
METHODS: The hospital records of all patients admitted to the geriatric medicine ward in 2016 were retrospectively audited.
RESULTS: An ARP was completed before separation for 333/442 (75.3%) admissions. In the event of arrest, 240 (54.3%) patients had an ARP specifying “care of the dying”, 93 (21.0%) had an ARP specifying “cardiopulmonary resuscitation” and 109 (24.7%) had no resuscitation plan. Age 85-94 years (OR 1.65, P = 0.04) and =95 years (OR 9.59, P = 0.003), as well as Charlson index of comorbidity =2 (OR 3.4, P < 0.001), Australian-born (OR 2.09, P = 0.002) and admission during October-December (OR 3.81, P < 0.001) were independently associated with increased use of ARPs.
CONCLUSIONS: Acute resuscitation plan use was associated with older age, higher comorbidity, birth in Australia and admission later in the year.
Most people die when they are old, with multiple pathologies, and while living with frailty or dementia. These circumstances need the specialist skills of geriatric medicine. Death may not be unexpected, but survival and restoration of function are usually uncertain, influencing the approach to medical intervention. Assessment considers medical, functional, mental, social and environmental domains. Care requires a mix of acute, rehabilitation, mental health and palliative expertise, and evolves with changing circumstances. Relief of suffering and maintenance of function are key goals, but not the only ones. Mental distress is as common as physical; investigation- and treatment-burden are important; drug treatments are prone to adverse effects. A focus on person-centredness rather than the end-of-life is needed. This prioritizes respect for individual diversity in needs, assets and priorities, and rigorous decision making, to achieve what is the right intervention for that person at that time.
BACKGROUND: Maintaining quality of life including physical functioning is highly prioritized among older cancer patients. Geriatric assessment is a recommended approach to identify patients with increased vulnerability to stressors (frailty). How frailty affects quality of life and physical functioning in older cancer patients has scarcely been investigated.
AIM: Focusing on physical functioning and global quality of life, we investigated whether frailty identified by a geriatric assessment was associated with higher risk of quality-of-life deterioration during cancer treatment and follow-up.
DESIGN: Prospective, observational study. Patients were classified as frail or non-frail by a modified geriatric assessment. Quality of life was measured using the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire at inclusion, 2, 4, 6 and 12 months.
SETTING: Eight Norwegian outpatient cancer clinics.
Patients Patients >=70 years with solid tumours referred for palliative or curative systemic medical cancer treatment.
RESULTS: Among 288 patients included, 140 (49%) were frail and 148 (51%) non-frail. Frail patients consistently reported poorer scores on all functioning and symptom scales. Independent of age, gender and major cancer-related factors, frail patients had significantly poorer physical functioning and global quality of life during follow-up, and opposed to non-frail patients they had both a clinically and statistically significant decline in physical functioning from baseline until 12 months.
CONCLUSIONS: Geriatric assessment identifies frail patients with increased risk of physical decline, poor functioning and high symptom burden during and following cancer treatment. Frail patients should therefore receive early supportive or palliative care.
Aim: To examine the effect of a video-supported nurse-led advance care planning to frail geriatric patients on end-of-life decision-making outcomes in patients and their carers.
Design: This is a double-blinded randomized controlled trial with parallel arms.
Methods: The protocol was approved by the Institutional Review Board of the participating hospital on 1 August 2018. Frail elders and their carer if any are enrolled during hospitalization, and undergo randomization after discharged. The intervention group receives a 2-week video-supported nurse-led advance care planning programme (N = 149) while the control group receives a 2-week health education program at home (N = 149). Follow-up surveys via telephone at 1 and 6 months measure outcomes regarding end-of-life decision-making from both the patients and the carers.
Conclusion: Advance care planning discussion is to understand patient's values, preferences and treatment for care on their anticipation of future deterioration. Treatment options for end-of-life care may not be well-received especially elders because in the discussion process, technical medical terms are presented in an abstract, hypothetical way that are hard to understand. The present study aims to evaluate the effect of a nurse-led advance care planning supplementing with a video showing end-of-life treatment options to promote end-of-life care decision-making among frail geriatric patients.
Impact: The results will help identify effective elements of advance care planning and inform the development of an evidence?based structured advance care planning intervention in response to the need for quality end-of-life care.
Contexte : Notre société s'efforce d'améliorer la prise en charge des personnes en fin de vie et de respecter leur volonté (Loi Léonetti.). Cependant les souhaits des patients ne sont pas suffisamment honorés et les dispositifs proposés par les différentes lois ne sont pas plébiscités. Le médecin généraliste est le soignant de proximité amené à prendre en charge la fin de vie en ville. Cependant les patients ne perçoivent pas les médecins comme des interlocuteurs privilégiés pour discuter de la fin de vie. Il est nécessaire de mieux communiquer avec les patients si nous voulons nous adapter à leur volonté.
Objectif : L'objectif de cette étude était d'identifier les attentes des personnes âgées non démentes concernant l'abord de leur fin de vie. Méthode : Étude qualitative par entretiens semi dirigés compréhensifs de personnes âgées d'au moins 65 ans, non démentes, recrutées dans deux cabinets de médecine générale aux alentours de Montpellier. Après transcription intégrale, les verbatims ont fait l'objet d'une analyse par théorisation ancrée.
Résultats : Dix entretiens d'une durée moyenne de quarante minutes ont été réalisés. Les participants souhaitaient aborder le sujet de la fin de vie avec leur famille proche et transmettre leurs désirs verbalement, de manière informelle. Plusieurs n'envisageaient pas l'écrit comme moyen de transmission. Le sujet était souvent abordé à l'occasion d'un décès de tiers. Ils considéraient la fin de vie comme un sujet complexe, sensible et désagréable ce qui les conduisait à éviter d'en parler et d'y réfléchir de manière approfondie. Ils la percevaient principalement au travers de représentations négatives et la considéraient comme un évènement inéluctable, obscur, variable et imprévisible. Ils exprimaient des désirs assez généraux portant sur les conditions de leur fin de vie.
Conclusion : Les solutions proposées par la société ne semblent pas adaptées aux attentes des patients pour leur fin de vie : les soignants sont présentés comme les principaux interlocuteurs et c'est plutôt l'expression de directives précises et formelles portant sur la manière de mourir qui est attendue. Il persiste également un tabou autour de la fin de vie qui limite la réflexion et les échanges à son sujet.
Origine : BDSP. Notice produite par BIUSANTE HAnR0xBn. Diffusion soumise à autorisation
Purpose: The purpose of this study was to prospectively validate the Korean Cancer Study Group Geriatric Score (KG)-7, a novel geriatric screening tool, in older patients with advanced cancer planned to undergo first-line palliative chemotherapy.
Materials and Methods: Participants answered the KG-7 questionnaire before undergoing geriatric assessment (GA) and first-line palliative chemotherapy. The performance of KG-7 was evaluated by calculating the sensitivity (SE), specificity (SP), positive and negative predictive value (PPV and NPV), balanced accuracy (BA), and area under the curve (AUC).
Results: The baseline GA and KG-7 results were collected from 301 patients. The median age was 75 years (range, 70 to 93 years). Abnormal GA was documented in 222 patients (73.8%). Based on the = 5 cut-off value of KG-7 for abnormal GA, abnormal KG-7 score was shown in 200 patients (66.4%). KG-7 showed SE, SP, PPV, NPV, and BA of 75.7%, 59.7%, 84.4%, 46.0%, and 67.7%, respectively; AUC was 0.745 (95% CI, 0.687 to 0.803). Furthermore, patients with higher KG-7 scores showed significantly longer survival (p=0.006).
Conclusion: KG-7 appears to be adequate in identifying patients with abnormal GA prospectively. Hence, KG-7 can be a useful screening tool for Asian countries with limited resources and high patient volume.
The geriatric (=65 years of age) population is one of the fastest growing age groups in the United States. As this number increases, so does the number of geriatric trauma patients. Because this group has higher mortality rates and requires more resources, a Geriatric Trauma Palliative Care Program was created at a Level 1 Trauma Center in Dallas, TX, to provide concurrent lifesaving therapies and primary palliative care to older adults. The trauma program implemented the American College of Surgeons (ACS) Trauma Quality Improvement Program Palliative Care Best Practices Guidelines (ACS, 2017) to better care for acute traumatic injuries as well as the specific spiritual, emotional, and psychiatric needs of the geriatric trauma palliative care patient and family. Using the guidelines, the team performed a gap analysis, carried out program development, created a palliative care pathway to guide our evidence-based practice implementation, and performed retrospective chart reviews for 3-month pre- and postimplementation analysis. Using Person's 2 test and Fisher's exact test, our initial evaluation of the program showed statistically significant (p < .001) improvements in the measures related to the implementation of primary palliative care, pain and symptom management, and end-of-life care. The guidelines gave the team a consistent framework for implementing the basic competencies required to deliver primary palliative care, pain and symptom management, and end-of-life care to trauma patients.
OBJECTIVES: To explore how psychology trainee death concerns and ageist behavior relate to their willingness and desire to work with older adults.
METHOD: Trainees (N = 104; 80.8% women) completed the Death Thought-Accessibility Measure, Relating to Older People Evaluation (ROPE), Death Anxiety Scale-Extended (DASE), and Beck Anxiety Inventory (BAI) and rated their willingness and desire to work with older adults and their willingness to obtain training on how to work with older adults.
RESULTS: Pearson correlations showed that salience of death-related thoughts, death anxiety (but not general anxiety), and negative behaviors toward older adults were significantly negatively associated with trainees' willingness and desire to work with older adults. Regressions revealed that negative behaviors toward older adults was the strongest factor associated with willingness and desire to work with older adults, whereas positive behaviors toward older adults was the strongest factor associated with being willing to obtain training in working with older adults. Death anxiety and salience of death-related thoughts positively correlated with each other and were each positively associated with negative behaviors toward older adults.
CONCLUSION: Helping graduate trainees become more comfortable with mortality and changing negative behaviors toward older adults may increase their interest in gerontology and geriatrics.
BACKGROUND: The value of defining goals of care (GoC) for geriatric patients is well known to the palliative care community but is a newer concept for many trauma surgeons. Palliative care specialists and trauma surgeons were surveyed to elicit the specialties' attitudes regarding (1) importance of GoC conversations for injured seniors; (2) confidence in their own specialty's ability to conduct these conversations; and (3) confidence in the ability of the other specialty to do so.
METHODS: A 13-item survey was developed by the steering committee of a multicenter, palliative care-focused consortium and beta-tested by trauma surgeons and palliative care specialists unaffiliated with the consortium. The finalized instrument was electronically circulated to active physician members of the American Association for the Surgery of Trauma and American Academy for Hospice and Palliative Medicine.
RESULTS: Respondents included 118 trauma surgeons (8.8%) and 244 palliative care specialists (5.7%). Palliative physicians rated being more familiar with GoC, were more likely to report high-quality training in performing conversations, believed more palliative specialists were needed in intensive care units, and had more interest in conducting conversations relative to trauma surgeons. Both groups believed themselves to perform GoC discussions better than the other specialty perceived them to do so and favored their own specialty leading team discussions.
CONCLUSIONS: Both groups believe themselves to conduct GoC discussions for injured seniors better than the other specialty perceived them to do so, which led to disparate views on the optimal leadership of these discussions.
BACKGROUND: Despite an aging population and increasing number of geriatric trauma patients annually, gaps in our understanding of best practices for geriatric trauma patients persist. We know that trauma center care improves outcomes for injured patients generally, and palliative care processes can improve outcomes for disease-specific conditions, and our goal was to determine effectiveness of these interventions on outcomes for geriatric trauma patients.
METHODS: A priori questions were created regarding outcomes for patients age 65+ with respect to care at trauma centers versus non trauma centers and use of routine palliative care processes. A query of MEDLINE, PubMed, Cochrane Library, and Embase was performed. Letters to the editor, case reports, book chapters, and review articles were excluded. GRADE methodology was used to perform a systematic review and create recommendations.
RESULTS: We reviewed 7 articles relevant to trauma center care and 9 articles reporting results on palliative care processes as they related to geriatric trauma patients. Given data quality and limitations, we conditionally recommend trauma center care for the severely injured geriatric trauma patients, but are unable to make a recommendation on the question of routine palliative care processes for geriatric trauma patients.
CONCLUSION: As our older adult population increases, injured geriatric patients will continue to pose challenges for care, such as comorbidities or frailty. We found that trauma center care was associated with improved outcomes for geriatric trauma patients in most studies, and that utilization of early palliative care consultations was generally associated with improved secondary outcomes, such as length of stay, however inconsistency and imprecision prevented us from making a clear recommendation for this question. As caregivers, we should ensure adequate support for trauma systems and palliative care processes in our institutions and communities and continue to support robust research to study these and other aspects of geriatric trauma.
LEVEL OF EVIDENCE: Systematic review/guideline, Level III.
Compared to younger individuals, the prevalence of end-stage renal disease (ESRD) in elders is notably higher. While renal replacement therapy, usually with hemodialysis, is accepted therapy in younger patients with ESRD, decisions regarding the treatment of advanced kidney disease in the elderly population are more complex, secondary to the physiologic changes of aging, concurrent geriatric syndromes, and varying goals of care. Evaluation for possible initiation of dialysis in geriatric patients should be multidisciplinary in nature and patient-focused, including a consideration of physical, cognitive, and social function. If renal replacement therapy is not pursued, optimization of medical management or symptom management needs to be the goal of care.
OBJECTIVES: The aim of the present study was to evaluate the association between sarcopenia, diagnosed by different muscle mass measurement techniques, with nutritional status and overall survival in patients with advanced cancer under palliative care.
AIM: To investigate the association of sarcopenia, according to distinct muscle mass measurement methods, with nutritional status and overall survival (OS).
METHODS: This observational and prospective study, including 334 patients, defined sarcopenia as reduced muscle mass and strength. Muscle mass was evaluated adopting 3 different methods, mid-upper arm muscle area (MUAMA), calf circumference (CC) and appendicular skeletal muscle mass (ASMI) described by Baumgartner (1998) and adjusted for height. Strength was defined using a handgrip dynamometer and OS was established based on a 90 days follow-up after inclusion date. Kaplan-Meier curves were conducted for survival analyzes and the association between sarcopenia and OS was evaluated by Cox regression model RESULTS: Prevalence of sarcopenia varied from 27-65% according to the method used to evaluate muscle mass. Malnutrition assessed by different parameters was significantly higher in patients with sarcopenia. Patients considered sarcopenic by MUAMA (43 versus 67 days, p<0.001), CC (44 versus 77 days, p<0.001) and ASMI (48 versus 75 days, p<0.001) had significantly lower OS compared to non-sarcopenic patients. Sarcopenia evaluated by MUAMA (HR, 1.57; 95% CI, 1.12-2.18) and CC (HR, 2.00; 95% CI, 1.45-2.76) showed a higher risk of mortality.
CONCLUSION: Sarcopenia diagnosed by MUAMA and CC could predict mortality and CC proved to be the best prognostic method for estimating OS in patients with advanced cancer in palliative care.
Les directives anticipées (DA) ne sont pas suffisamment appliquées en milieu hospitalier gériatrique malgré leur large diffusion depuis la publication de la loi Claeys-Leonetti. Lâ€™objectif de cette étude était dâ€™analyser lâ€™état des connaissances des gériatres sur la notion des directives anticipées et dâ€™évaluer leurs pratiques dans le processus dâ€™information du patient et du recueil des DA.