Palliative care in Hospitalized Middle-Aged and Older Adults With COVID-19

Abstract

Background : As COVID-19 overwhelms health systems worldwide, palliative care strategies may ensure rational use of resources while safeguarding patient comfort and dignity. Aim : To describe palliative care practices in hospitalized middle-aged and older adults in two of the largest COVID-19 treatment centers in Sao Paulo, Brazil. Design : Retrospective cohort Setting/participants : Eligible patients were those aged 50 years or older hospitalized between March and May 2020 with a laboratory confirmation of SARS-CoV-2 infection. Palliative care implementation was defined as present if medical notes indicated a decision to limit escalation of life support measures, or when opioids or sedatives were prescribed for palliative management of symptoms. Results : We included 1162 participants (57% male, median 65 years). Overall, 21% were frail and 54% were treated in intensive care units, but only 17% received palliative care. Stepwise logistic regression demonstrated that age ≥80 years, dementia, history of stroke or cancer, frailty, having a PaO 2 /FiO 2 <200 or a C-reactive protein ≥150mg/dl at admission predicted palliative care implementation. Patients placed under palliative care stayed longer (13 vs.11 days) and were more likely to die in hospital (86 vs.27%). They also spent more days in ICU and received vasoactive drugs, hemodialysis, and invasive ventilation more frequently. Conclusions : one in five middle-aged and older adults hospitalized with COVID-19 received palliative care in our cohort. Patients who were very old, multimorbid, frail, and had severe COVID-19 were more likely to receive palliative care. However, it was often delayed until advanced and invasive life support measures had already been implemented.

Specialist Palliative Care Consultations in COVID-19 Patients in the ICU—A Retrospective Analysis of Patient Characteristics and Symptoms at a German University Hospital

“…In their cohort, 39% received an inpatient sPC consultation, and these were more likely to be older and more affected by diseases. In our study, 19.5% of all ICU hospitalized COVID-19 patients received sPC, which is comparable to other investigations regarding all hospitalized patients [ 31 , 37 ]. In our cohort, 62.8% of the patients died during sPC involvement, which is similar to the mortality rate in the study by Sheehan and colleagues (56.3%, with 57.7% of them receiving sPC).…”

“…The retrospective analysis showed an association of age, serious illness such as cancer, chronic obstructive pulmonary disease, dementia and greater illness severity to sPC consultations [ 36 ]. In patients aged 50 years or older, Almeida and colleagues found age ≥ 80 years, dementia, history of stroke or cancer, frailty, PaO 2 /FiO 2 < 200 or C-reactive protein ≥ 150 mg/dL at admission were predictors of sPC implementation [ 37 ]. The overall sPC involvement rate in their retrospective cohort from March to May 2020 was 17% [ 37 ].…”

“…In patients aged 50 years or older, Almeida and colleagues found age ≥ 80 years, dementia, history of stroke or cancer, frailty, PaO 2 /FiO 2 < 200 or C-reactive protein ≥ 150 mg/dL at admission were predictors of sPC implementation [ 37 ]. The overall sPC involvement rate in their retrospective cohort from March to May 2020 was 17% [ 37 ].…”

Delivering patient-centered care: outcomes of comprehensive geriatric assessment across healthcare settings

“…[96][97][98] While COVID-19 adverse effects are greater in older people, previous work highlighted that age itself should not be used to define the prognosis of this disease. [99][100][101][102][103] On the contrary, COVID-19 prognosis depends primarily on the interactions between acute illness severity with previous functional status, determined by vulnerability measures (eg, frailty, functional disability, cognitive impairment). 104 As the pandemic advances, awareness has shifted to the long-term consequences of COVID-19.…”

Palliative care for cancer patients during the COVID‐19 pandemic: A narrative synthesis from 36 studies of 16 countries

“…During this period, palliative care patients had longer hospital stays, higher mortality and infection rates, and poorer prognosis. Demand for palliative care is rising among cancer patients, putting them at risk of contracting COVID‐19 (Almeida et al, 2022; de Oliveira, da Costa Rosa, et al, 2021; de Oliveira, Rosa, et al, 2021; Fazilat‐Panah et al, 2022; Jeba, 2020; Moriyama et al, 2021; Onesti et al, 2021; Rahnea‐Nita et al, 2021; Strang et al, 2021; Tashkandi et al, 2021). Palliative care facilities have also been hit by the viral outbreak.…”