116 / 290
patients. Skin and heart valves are waiting to be transplanted. In the
Netherlands donation following euthanasia is legalized and has been
performed only14 times. With the increased interest in euthanasia,
the growing organ shortage and the established expert guide in 2015,
we expect more requests for organ donation following euthanasia.
P-306
Knowledge of local Electronic Palliative Care Co-ordination
Systems (EPaCCS) within a Multidisciplinary Team at a District
General Hospital
K. Khan-Mahmood
1
, N. Jaafar
1
, D. Coates
1
.
1
Colchester General Hospital,
Colchester, United Kingdom
Introduction:
The increasing prevalence of frailty extrapolates to
higher numbers of patients rapidly approaching the end of their life.
Discussions of wishes at the end of life are not always translated
from community to hospital on admission. This can lead to failure of
wishes being respected. There are a number of electronic databases
being created such as EPaCCS, or My Care Choices (MCC). Is there an
awareness of these tools amongst the multi-disciplinary team (MDT)?
Methods:
We randomly assessed healthcare professionals via ques-
tionnaires. We questioned nurses, foundation year doctors, GP
trainees, core medical trainees, specialist registrars, and consultants.
We surveyed six wards (all 4 elderly care wards, A&E and EAU).
Results:
There were 77 respondents (Elderly:Acute = 44:33). In the
wards questioned, staff aware of its existence were 79% (35/44) elderly
vs 24% (8/33) on acute. Of the healthcare workers surveyed, core
medical trainees displayed the lowest awareness (38%) and GP trainees
(83%) the highest. In the emergency department there was no
recognition or knowledge of the MCC register, slight improvement in
EAU, overall the knowledge on elderly care wards was much better.
Conclusion:
A&E is the first point of contact in the hospital journey;
our results show this is where knowledge of the MCC is very
poor, impacting on appropriate rates of admission. Knowledge of
this communication tool at the front door will help tailor initial
management thus improving overall outcome and wishes.
P-307
The nature of the caregiving experience: a qualitative study
C. Laranjeira.
RECI I&D
–
Piaget Institute, Viseu, Portugal
Objectives:
As ever-increasing numbers of family members take on
the responsibility of providing care at the end of life, there is a
increasing need to assess caregiver learning needs and processes. This
study explicates what family members learn during the process of
providing end-of-life care.
Methods:
This qualitative study employed semistructured interviews,
and we analyzed data using grounded theory and qualitative methods.
We recruited 14 Portuguese family caregivers from a medical care unit
at an academic medical center.
Results:
The mean age of participants was 59 years (SD = 17) and the
majority were women. Thematic and cross-comparative analyses
found three general kinds of learning that were described
—
knowledge
about: (a) the illness, (b) how to assist the patient, and (c) how to
access health services. In some cases, participants
’
reports about
attitudinal learning appeared to reflect an ongoing effort to convince
or remind themselves of something they were struggling to achieve
or accept in order to cope with their situation.
Conclusion:
The caregivers exposed themselves to emotional diffi-
culties and an increased need for support and information. Findings
can inform the development of individualized educational programs
and interventions for family caregivers.
P-308
Elderly persons in hospice. From palliative care to euthanasia:
ethical considerations
J.C. Leners.
Palliative Care and Hospice, Luxembourg
Objective:
To find out the details of all elderly persons admitted since
its beginning.
Method:
Since 6 years, Luxembourg created a unique fifteen beds
hospice and we produced a statistical analysis of all seniors
admissions.
Results:
Nearly 72% of the population is above 75 years. The admission
rate per year varies between 120 and 140 and the most important
diseases for the elderly people are: 64% have an end-stage tumor; 16%
terminal respiratory problems; 13% terminal heart failure and 7% pure
neurological diseases. Of all senior patients, some 21% have written
living wills, expressing clearly that in case of unbearable pain or
discomfort, they wish a terminal sedation. The data suggest that only
18% of this population made an oral request for this type of sedation.
The mean duration of a sedation is 2,5 days. For the other patients
expressing the wish for euthanasia (as legally allowed), we have
registered some 42 in advance written requests. Most of all these
elderly persons will not ask for euthanasia, but the natural process
of the disease will lead prior to death. Should there be a repeated
oral request for euthanasia, the process will be as follows: ethical
considerations from the whole team in a meeting, where the accuracy
of the demand is debated. Should there be other options considered,
p.ex.temporarily or terminal sedation; inactivation of an implantable
defibrillator, the stopping of nocturnal respiratory assistance, etc the
physician will discuss these possible alternatives with the patient.
Conclusion:
More than half of all requests for euthanasia turn to a
terminal sedation and very few seniors stick to their initial demand.
(less than 5%)
P-309
DemFACTS
—
antibiotics for pneumonia and artificial hydration for
insufficient fluid intake in advanced dementia
A. Loizeau
1
, S. Eicher
1
, N. Theill
1
, M. Martin
1,2
, F. Riese
2,3
.
1
University of
Zurich, Center for Gerontology,
2
University of Zurich, University Research
Priority Program
“
Dynamics of Healthy Aging
”
,
3
Psychiatric University
Hospital Zurich, Division of Psychiatry Research and Psychogeriatric
Medicine, Zurich, Switzerland
Objectives:
About two-thirds of people with dementia die from
pneumonia and one-third die from dehydration. The DemFACTS study
aims to develop and test decision aids called fact boxes, in order to
support decision-makers, who have to make treatment decisions at
the end-of-life of people with dementia and either pneumonia or
insufficient fluid intake.
Methods:
The study employs a randomized, controlled, pre-/post-
intervention design. Relatives of people with dementia (n = 100),
professional proxies (n = 100) and physicians (n = 100) will evaluate
the newly developed fact boxes. At pretest, participants will be asked
to make two fictional decisions concerning burdensome medical
interventions in advanced dementia based on case vignettes. Four
weeks later, at posttest, the intervention group will be presented with
two fact boxes in addition to the two case vignettes, whereas the
control group will only be provided with the case vignettes.
Expected results:
The fact boxes
’
effect on decisional conflicts
(primary outcome), additional decision outcomes, knowledge trans-
fer, and the appropriateness of the fact boxes (secondary outcomes)
will be assessed.
Conclusion:
The fact boxes could reduce the decision-makers
’
deci-
sional conflicts and enable them to better understand the treatment
decisions. Improving knowledge transfer in palliative care decision-
making could have a major impact on how decision-making aids in
this field will be shaped in the future.
P-310
Follow-up of pressure ulcers according to the feed
E. García Tercero, T. Martínez Maroto, M. Araújo Ordóñez, M.C.
Bejarano Gómez, M. Bravo García, E. Villamora Fernández.
Hospital
Virgen del Valle
Introduction:
The presence of patients with pressure ulcers (PU) in
old people
’
s home is not a rare event, requiring a higher consumption
of human, technical and nutritional resources, since it is known the
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
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S110