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had three or more co-morbidities with 26% (18/69) having six or more

co-morbidities. It is therefore likely that the Charlson comorbidity

index could be applicable in this group and help provide insightful

prognostication discussions, should this be wanted.


Multiple comorbidities are very common in our ward

patients but resuscitation and escalation decisions are often poorly

discussed and documented. The Charlston co-morbidity index poten-

tially offers professionals a reality check tool to help facilitate these

difficult discussions, which we intend to explore further.


How we die in hospitals

L. Fernandes, D. Cardoso, R. Morais, A. Botella, P. Moniz, A. Miranda,

J. Dantas, M. Malheiro, J. Pereira, D. Rei, J. Rodrigues, E. Cacheira,

I. Verdasca, A. Leitão, C. Fonseca, L. Campos.

S. Medicina UF III, HSFX,



Medical advances have allowed an increase of average

life expectancy although associated with more chronic disease,

complications and hospitalization. Simultaneously, death is no longer

seen as a natural continuum of life. The lack of ambulatory support

structures and families

inability to accept life

s final stage have led to a

tendency, in industrialized countries, for the majority of deaths to

occur in hospitals. We examined what occurred during patients

last 5

days of life in our medical ward.

Material and methods:

We conducted a retrospective observational

study, spanning 13 months. Data was collected from clinical records.


In the studied period, 75 deaths occurred (10,7% mortality

rate). Of these, 70 were included due to the othe

s missing data.

Mean average age was 82 years, 67% females, 48,6% with an ECOG

performance status

3, and 32% with 3 or more hospitalizations in

the previous year. Underlying infection was the main cause of death,

followed by cancer and cardiovascular, despite terminal cancer

diagnosis in 43%. In most cases, agonizing phase was not explicitly

mentioned, although 46% had reports of 3 or more typical symptoms/

signs. Of these, 97% were subjected to invasive procedures during their

last days.


Recognizing agonizing phase requires experience. How-

ever, age, co-morbidities, functional status and hospitalizations in the

last year should be sufficient to predict death as a likely outcome. In

acute hospitals (more prepared for healing than palliation) we use a

high number of complementary means and procedures promoting

therapeutic futility, thus preventing dignified and painless death.


"Doing nothing is like a death sentence

: dilemmas for guardians

of patients with advanced dementia regarding tube feeding In


E. Gil


, M. Agmon


, A. Hirsch


, A. Zisberg




Geriatric Unit, Bnei Zion

Medical Center,


Gatroenterology Institute, Bnei Zion Medical Center,


Medicine Faculty, Technion Institue of Technology,


School of Nursing,

Haifa University, Haifa, Israel


Advanced dementia is an incurable illness. Its last stage

is marked by inability to eat. Tube feeding was deemed a helpful

solution at this stage, but in recent years its inefficiency has been

proven, and it is no longer practiced in many countries around the

world. In Israel this procedure is still common. In the gastroenterology

institute at the Bnai Zion medical center, patients

legal guardians are

invited to a unique clinic, were they receive detailed information about

tube insertion procedure. The great majority of guardians choose the

gastrostomy (tube) option, despite the clinic staff

s recommandation

against it.


To examine the considerations underlying the decision

process of advanced dementia patients

guardians for gastrostomy,

despite the information and the recommendations.


Qualitative research, including observation of participant-

physician interaction at the clinic and in-depth interviews with 20

guardians. The main themes were extracted by a triangulation process

conducted by the research team.


The families of most patients had never discussed end-of-

life Issues with their relatives. The overwhelming preference of using

the technology was interpreted as life-saving, in contrast to comfort

feeding, which was considered euthanasia. The reasons given for

the decision were drawn from a range of outlooks: religion, patient


earlier capacity for survival, and pragmatic considerations involving

relations with the nursing home where the patient resided.


The results shed new light on the layers of meaning of

the discourse regarding end-of-life issues in the Israeli health care



Knowledge of the truth in the terminal patient

M.M. González, I. Ferrando, M.C. Deza, C. Cánovas.

Hospital Nuestra

Señora de Gracia, Zaragoza, España


We know that the patient has de right to know the truth

about the severity of his illness and its evolution. Sometimes the

family conceal that information with the objective of


the patient

. We want to know the main caregiver

s opinion about the


s knowledge of the truth, in a terminal stage.


This is a descriptive and prospective study with inpatients

between October and December 2015. The caregiver is asked:


the patient suffered from a severe illness in a terminal stage, and he

maintained his comprehension skills, would he want real information

about his illness, and if the answer is negative, what is the reason

for this.


172 patients were included, mean age was 86,65. 64,5%

women. Barthel at discharge: <20:37,5%, >60:25,1%. Medical history:

tumor 22, High Blood Pressure 116, cardiac insufficiency 50, Chronic

Obstructive Pulmonary Disease 32, diabetes 36, renal failure 37,

thyroid disease 13, arthrosis 71, stroke 45, dementia 76, Parkinson

disease 8, depression 35. In the evento of severe illness with terminal

stage criteria:45,3% would like the patient to know nothing about his

illness, 25% what the physician considers as appropriate, 9,3% only

selected information and 14% all of the real information. The reasons

not to inform would be: 32% wouldn

t understand, 11% would get

anxious, 6,4% would get depressed, 0,6% gives no reasons.


A high percentage of older inpatients

caregivers don


support giving true information to the patient about their illness, by

fear to encourage their suffering, decreasing their right to the

knowledge of the truth and restricting their capacity of decision

making about their illness. It is necessary to improve the communi-

cation with the patient



Organ donation following euthanasia

K. Goossens, R.L. van Bruchem-Visser.

Erasmus MC

We like to present the first patient who underwent organ donation

following euthanasia in our hospital. A 53-years old man suffered

from a large stroke of the left hemisphere with hemiparesis of his right

arm and leg and motor aphasia in 2009. Until that moment, he was an

international operating businessman. Because of lack of quality of life

and no sign of improvement, he asked his doctor for euthanasia. In

2015, a psychiatrist from the Stichting Levenseinde Kliniek (SLK) as

well as an independent physician approved of his request. The patient

had a great desire to donate as much of his body as possible. For this

reason the transplantcoordinator of our hospital was contacted. We

met the patient to obtain the certainty that there was a serious wish

to donate, apart from the euthanasia request. After our conversation

with him and his family, Erasmus MC decided to honor his request

for donation following euthanasia. The euthanasia was performed on

the department of internal medicine of our hospital by the psychiatrist

of the SLK. Immediately after confirmation of death the body was

transported to the operation room where organs were taken out. The

lungs, kidneys and corneas were successfully transplanted to five

Poster presentations / European Geriatric Medicine 7S1 (2016) S29