BACKGROUND Barriers to palliative care still exist in long-term care settings for older people, which can mean that people with advanced dementia may not receive of adequate palliative care in the last days of their life; instead, they may be exposed to aggressive and/or inappropriate treatments. The aim of this multicentre study was to assess the clinical interventions and care at end of life in a cohort of nursing home (NH) residents with advanced dementia in a large Italian region. METHODS This retrospective study included a convenience sample of 29 NHs in the Lombardy Region. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the 7 days before death. RESULTS Most residents (97.1%) died in the NH. In the 7 days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs were prescribed. Fifty-seven percent of residents had an acknowledgement of worsening condition recorded in their clinical records, a median of 4 days before death. CONCLUSIONS Full implementation of palliative care was not achieved in our study, possibly due to insufficient acknowledgement of the appropriateness of some drugs and interventions, and health professionals' lack of implementation of palliative interventions. Future studies should focus on how to improve care for NH residents.

中文翻译：

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患有晚期痴呆症的疗养院居民生命的最后一周：一项回顾性研究。

背景 在老年人的长期护理机构中，姑息治疗仍然存在障碍，这可能意味着患有晚期痴呆症的人在生命的最后几天可能无法获得足够的姑息治疗；相反，他们可能会受到侵略性和/或不适当的治疗。这项多中心研究的目的是评估意大利一个大地区的一群患有晚期痴呆症的疗养院 (NH) 居民在临终时的临床干预和护理。方法 这项回顾性研究包括伦巴第大区 29 个 NH 的方便样本。数据收集自 482 名晚期痴呆症居民的临床记录，他们在死亡前在新罕布什尔州居住了至少 6 个月，主要集中在死亡前 7 天。结果 大多数居民 (97.1%) 死于新罕布什尔州。死亡前7天，20%通过口进食和补水，13.4%通过管饲。中位数为五种药物，通常是不适当的。57% 的居民承认其临床记录中记录了病情恶化的情况，平均时间为死亡前 4 天。结论 在我们的研究中，姑息治疗并未得到充分实施，可能是由于对某些药物和干预措施的适当性认识不足，以及卫生专业人员缺乏姑息干预措施的实施。未来的研究应该集中于如何改善新罕布什尔州居民的护理。