European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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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.
Conclusion: 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.
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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,
CHLO
Introduction: 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.
Results: 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.
Conclusion: 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.
P-303
"Doing nothing is like a death sentence ” : dilemmas for guardians
of patients with advanced dementia regarding tube feeding In
Israel
E. Gil 1,2, M. Agmon4, A. Hirsch2, A. Zisberg4. 1Geriatric Unit, Bnei Zion
Medical Center, 2Gatroenterology Institute, Bnei Zion Medical Center,
3Medicine Faculty, Technion Institue of Technology, 4School of Nursing,
Haifa University, Haifa, Israel
Introduction: 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.
Purpose: To examine the considerations underlying the decision
process of advanced dementia patients ’ guardians for gastrostomy,
despite the information and the recommendations.
Method: 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.
Findings: 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’ s
earlier capacity for survival, and pragmatic considerations involving
relations with the nursing home where the patient resided.
Conclusions: The results shed new light on the layers of meaning of
the discourse regarding end-of-life issues in the Israeli health care
setting.
P-304
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
Objectives: 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 “protecting
the patient”. We want to know the main caregiver’ s opinion about the
patient’s knowledge of the truth, in a terminal stage.
Methods: This is a descriptive and prospective study with inpatients
between October and December 2015. The caregiver is asked: “If
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.
Results: 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.
Discussion: A high percentage of older inpatients’ caregivers don’ t
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’ s.
P-305
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–S259 S109