Abstract
Objective: To identify the mode of death in hospitalized patients with Parkinson’s disease (PD), while evaluating their end-of-life care.
Background: Palliative care in advanced PD is now receiving a growing interest. However, knowledge about the overall patterns of the end-of-life of PD patients (regardless the severity of the disease) is limited. Understanding the current situation and local practice are critical to identify levers for action and improve hospital-based end-of-life care.
Design/Methods: All parkinsonian patients who died at the University Hospital of Rennes (France) between January 1st, 2006 and January 31st, 2018 were identified through a database screening. A retrospective chart review collected demographic and diagnostic information, clinical history, reason for hospital admission, drug charts, hospital length of stay and location of death.
Results: 62.1% of the 132 deceased patients (85 males, mean age 79.8 years old) were living at home prior to admission. 77.3 % were admitted through the hospital emergency department (ED). Main causes of admission included infections (N=30), falls (N=23), deterioration of general condition (N=16), cerebrovascular accident (N=9), gastrointestinal occlusion/obstruction (N=7) and cardiac events (N=6). 5 deaths occurred during a scheduled hospitalization. Neurological and palliative care consults were requested in only 12.8% and 15.1% of cases, respectively. Antiparkinsonian treatments were suspended/stopped prematurely in 42% of cases and alternative routes of administration considered in less than 10 cases. As patients reached the end of their lives, treatment consisted mainly of morphine, midazolam and/or scopolamine. Most deaths occurred in geriatric wards (N=30) and intensive care units (N=18) and were mainly due to cardiopulmonary arrest (N=60) or multiple organ failure (N=11).
Conclusions: Despite specific needs, PD patients do not benefit from specialized end-of-life care. Various interventions could be implemented: early involvement of the PD and palliative care specialist teams, or treatment with subcutaneous apomorphine (avoiding dopaminergic deprivation). The ED and geriatric wards are targets of choice.
Disclosure: Dr. Auffret has nothing to disclose. Dr. Morel has nothing to disclose. Dr. Robert has nothing to disclose. Dr. Verin has nothing to disclose.
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