[Emergency admissions from nursing homes to hospital at the end of life]. / Akutte innleggelser fra sykehjem til sykehus i livets sluttfase.

BACKGROUND: Admissions from nursing homes to hospital at the end of life have not been previously studied in Norway. The goal of this project was to document acute admissions to a Norwegian hospital for patients who died within 48 hours after hospitalization. MATERIAL AND METHODS: This study is based on information recorded in patient charts for admissions to Haraldsplass Deaconess Hospital, Bergen in the period 1.10. 2007-30.9.2008. Patients who were admitted from nursing homes and died within 48 hours after admission to the hospital were eligible for inclusion. Cooperation between nursing homes and the hospital and whether patients received appropriate palliative care was analysed. RESULTS: 26 patients, mean age 85.3 years, were included in the study. All of them had internal medicine problems. 12 patients had been assessed by a physician before admission. 14 patients had a written referral from a doctor and 18 patients had a note from a nurse. For eight patients no information was given about what was expected from the hospital and for four patients there was no information about medication. No documentation was available about verbal contact between the institutions before the admissions. In the hospital, diagnostic procedures were used for 24 patients and potentially life-prolonging treatment was started for 23 patients. Morphine was prescribed for 18 patients. INTERPRETATION: The results show that nursing home residents have inadequate access to physicians, and indicate that competence concerning evaluation of critically ill patients in nursing homes must be improved. Hospital physicians used a treatment focus in their patient approach. The cooperation and communication between nursing homes and the hospital functioned badly. Palliative care should be improved both in the hospital and the nursing homes.

Utilisation of specialist care in patients with incurable rectal cancer. a population-based study from Western Norway.

INTRODUCTION: About 25% of patients with rectal cancer have incurable disease at the time of diagnosis. In the current study from Western Norway (population of 981 000) we focused on the utilisation of specialist care in patients with primarily incurable rectal cancer. PATIENTS AND METHODS: Between 1997 and 2002, 1 167 patients were diagnosed with rectal cancer, of whom 297 (25%) had incurable disease, according to consecutive and prospective reporting to the Norwegian Colorectal Cancer Registry. Consumption of specialist care facilities was studied with regard to outpatient contacts, hospital admissions, and various treatment modalities. Data were analysed with regard to age, sex, marital status, type of residence, and geographical access to hospital facilities. Data were available for 287 patients (97%). RESULTS: The median age was 77 years. Elderly patients (>77 years) more often lived in nursing homes without a spouse. About 60% of the patients were treated with major surgery, chemotherapy or radiotherapy, either alone or in combination. Of those who did not receive such treatment, 87% were elderly. Oncological treatment, either alone or combined with surgery, predicted increased hospital admissions and outpatient contacts. Age >77 years predicted fewer hospital admissions. Survival varied statistically significantly with the various treatment modalities, and was highest for major resections combined with oncological treatment. The majority of the patients living at home died in hospitals (54%) and only 26% died in their homes, while two-thirds of residents of nursing homes died there. DISCUSSION: Patients with primary incurable rectal cancer are heterogeneous with regard to their needs of treatment. While younger patients receive extensive tumour-related treatment, elderly patients are most commonly treated according to their symptoms. Prospective studies of the effect of various treatment options on the ease of symptoms and improved quality of life in unselected populations are needed.

[The dying patient]. / Den døende pasient.

All doctors in clinical practice have to face dying patients. In order to give help to the patient and his nearest family, the doctor needs knowledge about the dying process and how to relieve suffering. Based on relevant literature and own clinical experience, we discuss the challenges of identifying the terminal phase, ethical issues concerning medical treatment, and how to offer adequate symptom relief. We describe how to relieve pain and other symptoms, and how to organise the care of the dying. Drugs that may be useful in relieving suffering are described with dosing proposals. Family members have to be helped as well with information and reassurance. A Norwegian Standard for Palliation focusing on the organisation of palliative and terminal care has recently been published.