Short summary

We aim at describing end of life along with identifying factors important at EoL by a perspective point of view from the old population ?65 years. Secondly, based on the perspectives and experiences, we develop a questionnaire and use this to characterize the 80 plus year old inpatient at the Emergency Department at two sites in the Region of Southern Denmark. Thirdly, we aim to investigate whether these end of life preferences remains stable over time.

Rationale

With an aging population, a growing number of older patients with multiple age-related co-morbidities and functional disabilities will occur(1). These patients are more vulnerable to acute deterioration in health, and at some point many of them will be hospitalized(2), including the fragile older individuals, who often are transferred unplanned to the emergency department(ED)(3). In Denmark the one-year mortality among 65 plus year old acutely admitted patients is approximately 20 % increasing with ageing to 37 % for the 80 plus year old patients(4). Thus, acute hospitalization at that age involves a high risk of mortality. Throughout acute hospitalization, the older patient and their families can be faced with decisions and tasks, they may not previously have considered, such as discussing end of life (EoL) preferences. Some of these patients could therefore be considered as being in or nearing the end of their life.

Acute hospitalization as we age is often unavoidable and the older patient is in high risk of being tangled up in this acute setting, where treatment is performed by healthcare professionals often without knowing, what matters to the older patient or which preferences that are preferred(20,21). Even though acute admission is definitely not the optimal place to be confronted with this subject for the first time, it seems reasonable to allow the patient the possibility of decision-making or reflection in EoL treatment, knowing the risk of mortality as mentioned above. The main intension should all together be a clarifying conversation that makes the decisions balanced between patient and physician preferences. Furthermore, reflection post-discharge with their general practitioner and family if wished should ensure comfort and the right to self-determination for the older patient. Until now no studies have evaluated the EoL care preferences or important factors at EoL among older people in Denmark.

This project is a mixed methods study and will, by a patient-centered approach, determine treatment preferences and factors important among older people in a general -and specific setting. Our aims are threefold; first, we aim at describing EoL along with identifying factors important at EoL by a perspective point of view from both dependent and independent elderly. Secondly, based on the abovementioned perspectives, we will characterize the 65 plus year old medical patient, throughout an acute admission, and their treatment preferences along with what they consider important at EoL. Thirdly, we aim to investigate whether these EoL preferences remain stable over time.

Description of the cohort

Inclusion criteria:  Older people ?65 years old admitted through the ED at OUH and SVS. 

Exclusion criteria: Participants unable to give informed consent to participate or if the person is known or believed to be cognitive impaired assessed by the nearest relative or nursing staff. 

Data and biological material

Questionnaire study.

Collaborating researchers and departments

Department of Regional Health Research, Center-Esbjerg, University of Southern Denmark and Simpson Centre for Health Services Research, University of NSW, Liverpool BC, 1871, NSW, Australia

• MD Stine Hanson

Migrant Health Clinic, Odense University Hospital; Center for Global Health, University of Southern Denmark and Health Sciences Research Center, University College Lillebaelt

• Associate Professor Dorthe Nielsen

Department of Emergency Medicine, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark

• Professor Annmarie Lassen

Department of Emergency Medicine, Hospital of South West Jutland and Institute of Regional Health Research, Center-Esbjerg, University of Southern Denmark

• Professor Mikkel Brabrand

Department of Geriatric Medicine, Odense University Hospital, Denmark and Institute of Clinical Research, University of Southern Denmark. 

• Associate Professor Jesper Ryg

Simpson Centre for Health Services Research, University of NSW, Liverpool BC, 1871, NSW, Australia and Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool BC, 1871, NSW, Australia

• Dr. Roberto Forero

Publications associated with the project

What Matters at the End of Life: A Qualitative Study of Older Peoples Perspectives in Southern Denmark. Hanson S, Brabrand M, Lassen AT, Ryg J, Nielsen DS. Gerontol Geriatr Med [Internet]. 2019;5:233372141983019.