[Risk factors for not benefiting from palliative care in end-of-life geriatric patients]. / Risques d'exclusion des soins palliatifs des patients en fin de vie dans un service gériatrique.

Palliative care should represent good medical practice for all clinicians. Their still exist many barriers to good palliative care in general and in geriatrics in particular. The present observational study aimed to identify these barriers. During the six months study period, patients hospitalized in a Belgian geriatric hospital and benefiting from palliative care were prospectively compared to those who died without palliative care. Nearly half of our patients died without access to palliative care. Compared to the patients who had received palliative care, these patients showed less often pain and more often dyspnea. Invasive medical interventions and use of antibiotics were more frequent in patients who died without access to palliative care. Benzodiazepines were used less frequently compared to palliative care patients. In patients who died without access to palliative care, communication with the patient was inferior as compared to palliative care patients. The former group showed more often cognitive impairment, social isolation, and a more rapid, unanticipated death. We identified the following risk factors for not benefiting from palliative care in geriatrics: absence of identified pain syndrome; presence of dyspnea; absence of oncologic diagnosis; social isolation and poor communication with the patient and her/his family; cognitive dysfunction and unexpected death.

[Pain assessment in non-communicative patients]. / Mesurer la douleur chez le patient non communicant.

Pain is a subjective experience. Its assessment is based on the subject's direct verbal report. This method of assessment is, however, impossible in patients who cannot communicate their feelings. In this context, indirect measurements such as behavioral observations or physiological measurements are needed. To facilitate the assessment of pain in non-communicative patients, numerous standardized behavioral scales have been developed. The aim of this review is to discuss the main validated pain scales employed in end-stage dementia, newborn and preverbal children, and severely brain damaged patients with a disorder of consciousness such as coma, the vegetative state or the minimally conscious state.