Palliativmedizin – auch im hohen Alter?

Zusammenfassung.

Fragestellung:

Brauchen alte Patienten in Pflegeeinrichtungen ein palliatives Behandlungskonzept in ihrer letzten Lebensphase?

Methodik:

Eine prospektive Untersuchung von 179 Todesfällen von 1998–1999 beleuchtet die palliative Versorgung und Aufklärung der Patienten vor dem Tod im Roten-Kreuz-Krankenhaus in Bergen.

Ergebnisse:

Das Durchschnittsalter der Patienten betrug 84,5 Jahre. 85% der Todesfälle waren erwartet. Bei 77% der Patienten wurden ausführliche Informationen Tage oder Stunden vor dem Todesfall gegeben. 83% der Patienten bekamen in den letzten 24 h Opioide, 67% von ihnen Morphin, 12% Benzodiazepine, 37% Scopolamin, 3% Haloperidol.

Schlussfolgerungen:

Schwerkranke und sterbende alte Patienten brauchen unbedingt alle Angebote der Palliativmedizin in der letzten Lebensphase.

Abstract.

Red Cross Clinic is the largest geriatric center in Norway (240 beds). Major parts of the center are: long time geriatric ward (215 beds), rehabilitation and acute ward (25 beds), day clinic (45 patients) and a teaching and research unit. A palliative care unit (10 beds) will be opened in spring 2000. In mai 1998 a national project: Palliative care for the elderly was opened at our center. The projects main goal is to develop and support proper palliative care to all severe ill and dying patients in Norway. In a prospective study we examined 179 consecutive deaths between 1998 and 1999. Average age was 84.5. Major symptom problems were pain, dyspnoea, death-rattle and anxiety. In the last 24 hours 83% of the patients received opioids, 67% of the cases morphine (mean daily dosage 31.8 mg). 37% of the patients received scopolamine (mean daily dosage 0.8 mg), 12% benzodiazepines and 3% of the patients haloperidol. 152 (85%) of the deaths were expected, 27 (15%) unexpected. In 137 patients (77%) open, honest, frank communication with patient or their nearest kin regarding the imminent death was possible. In our experience it is a myth that the relatives want doctors to practise “maximal therapy”. All old patients in geriatric clinics and nursing homes need palliative care. We have found no international textbooks of geriatrics with chapters on palliative care or textbooks on palliative care with chapters on the elderly. They need doctors and nurses who are properly trained and educated in palliative care. In most countries in Europe this training and education is not provided.