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Terminal care in oldest old dying from COVID-19 in the acute hospital: A multicenter study describing pharmacological treatment in the last 24 h
Background Coronavirus disease 2019 (COVID-19) has a high mortality, especially in the oldest old. Dying from COVID-19 is often characterized by symptoms such as breathlessness and agitation but data concerning medical treatment in the dying phase are limited. Objective This study describes the admi...
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| Published in: | Zeitschrift für Gerontologie und Geriatrie 2022-03, Vol.55 (2), p.129-134 |
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| container_end_page | 134 |
| container_issue | 2 |
| container_start_page | 129 |
| container_title | Zeitschrift für Gerontologie und Geriatrie |
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| creator | Janssens, Wim H. Van Den Noortgate, Nele J. Piers, Ruth D. |
| description | Background
Coronavirus disease 2019 (COVID-19) has a high mortality, especially in the oldest old. Dying from COVID-19 is often characterized by symptoms such as breathlessness and agitation but data concerning medical treatment in the dying phase are limited.
Objective
This study describes the administration of oxygen, opioids and benzodiazepines in the last 24 h before death in patients 80 years or older dying from COVID-19 on acute hospital wards.
Material and methods
In this multi-centric retrospective study, patients, 80 years and older, admitted to the acute hospital in March and April 2020 were recruited from 10 acute Belgian hospitals. They all were diagnosed with COVID-19 and died on non-ICU wards with COVID-19. Administration of oxygen, opioids and benzodiazepines in the last 24 h before death was registered.
Results
Eighty-five percent of patients received oxygen, half of them even by means of a mask providing at least 10l oxygen per minute. The majority (84.3%) of patients were treated with opioids (morphine). Mean dosage of SC morphine equivalent was 31.3 mg/24 h (range 2–120 mg; SD 21.6 mg). More than half of patients (52.8%) received benzodiazepines, mostly midazolam. Mean dosage of midazolam was 20.4 mg/24 h (range 1–100 mg; SD 15.4 mg). Dosages of morphine and midazolam did not differ depending on frailty or comorbidities. Older COVID-19 patients dying with respiratory failure had higher midazolam dosage (
p
0.002) but not morphine dosage (
p
0.11).
Conclusion
A high proportion of patients 80 years and older and dying with COVID-19 in the hospital, were treated with oxygen, opioids and benzodiazepines in the last 24 h before death. With this descriptive study, we hope to contribute to the discussion and further research on the optimization of symptom control in an older population dying from/with COVID-19. |
| doi_str_mv | 10.1007/s00391-022-02036-4 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8894836</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2636144961</sourcerecordid><originalsourceid>FETCH-LOGICAL-c353t-6b0961376b7ad87d806f86d35a7268d375a3bd5364ae24d40e0686a9bad221213</originalsourceid><addsrcrecordid>eNp9kD9PwzAQxS0EoqXwBRhQRpaA_-WcLEioFKhUqUthtZzYbVMlcbETpH57HFoqWBhON9y7d-9-CF0TfEcwFvceY5aRGFMaCjOI-QkaEs6SmFDITtEQZzyNQWA-QBfebzAmQgA5RwOWUM4F8CGaLIyry0ZVUaGcicomspU2vu1bpHdls4qWztbReP4-fYpJ1ivatYlU0bUmWlu_LVtVXaKzpaq8uTr0EXp7nizGr_Fs_jIdP87igiWsjSHHGRAmIBdKp0KnGJYpaJYoQSHVTCSK5TphwJWhXHNsMKSgslxpSgklbIQe9r7bLq-NLkzTOlXJrStr5XbSqlL-nTTlWq7sp0zTgIJBMLg9GDj70YU_ZV36wlSVaoztvKTAgHDepxwhupcWznrvzPJ4hmDZ85d7_jLwl9_8JQ9LN78DHld-gAcB2wt8GDUr4-TGdi7w9__ZfgEV-I81</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2636144961</pqid></control><display><type>article</type><title>Terminal care in oldest old dying from COVID-19 in the acute hospital: A multicenter study describing pharmacological treatment in the last 24 h</title><source>Springer Link</source><creator>Janssens, Wim H. ; Van Den Noortgate, Nele J. ; Piers, Ruth D.</creator><creatorcontrib>Janssens, Wim H. ; Van Den Noortgate, Nele J. ; Piers, Ruth D.</creatorcontrib><description>Background
Coronavirus disease 2019 (COVID-19) has a high mortality, especially in the oldest old. Dying from COVID-19 is often characterized by symptoms such as breathlessness and agitation but data concerning medical treatment in the dying phase are limited.
Objective
This study describes the administration of oxygen, opioids and benzodiazepines in the last 24 h before death in patients 80 years or older dying from COVID-19 on acute hospital wards.
Material and methods
In this multi-centric retrospective study, patients, 80 years and older, admitted to the acute hospital in March and April 2020 were recruited from 10 acute Belgian hospitals. They all were diagnosed with COVID-19 and died on non-ICU wards with COVID-19. Administration of oxygen, opioids and benzodiazepines in the last 24 h before death was registered.
Results
Eighty-five percent of patients received oxygen, half of them even by means of a mask providing at least 10l oxygen per minute. The majority (84.3%) of patients were treated with opioids (morphine). Mean dosage of SC morphine equivalent was 31.3 mg/24 h (range 2–120 mg; SD 21.6 mg). More than half of patients (52.8%) received benzodiazepines, mostly midazolam. Mean dosage of midazolam was 20.4 mg/24 h (range 1–100 mg; SD 15.4 mg). Dosages of morphine and midazolam did not differ depending on frailty or comorbidities. Older COVID-19 patients dying with respiratory failure had higher midazolam dosage (
p
0.002) but not morphine dosage (
p
0.11).
Conclusion
A high proportion of patients 80 years and older and dying with COVID-19 in the hospital, were treated with oxygen, opioids and benzodiazepines in the last 24 h before death. With this descriptive study, we hope to contribute to the discussion and further research on the optimization of symptom control in an older population dying from/with COVID-19.</description><identifier>ISSN: 0948-6704</identifier><identifier>EISSN: 1435-1269</identifier><identifier>DOI: 10.1007/s00391-022-02036-4</identifier><identifier>PMID: 35244764</identifier><language>eng</language><publisher>Heidelberg: Springer Medizin</publisher><subject>Aged, 80 and over ; Aging ; COVID-19 - drug therapy ; Geriatrics/Gerontology ; Hospitals ; Humans ; Internal Medicine ; Medicine ; Medicine & Public Health ; Original Contributions ; Retrospective Studies ; SARS-CoV-2 ; Social Sciences ; Terminal Care</subject><ispartof>Zeitschrift für Gerontologie und Geriatrie, 2022-03, Vol.55 (2), p.129-134</ispartof><rights>The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2022. corrected publication 2022</rights><rights>2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.</rights><rights>The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2022, corrected publication 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c353t-6b0961376b7ad87d806f86d35a7268d375a3bd5364ae24d40e0686a9bad221213</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,786,790,891,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35244764$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Janssens, Wim H.</creatorcontrib><creatorcontrib>Van Den Noortgate, Nele J.</creatorcontrib><creatorcontrib>Piers, Ruth D.</creatorcontrib><title>Terminal care in oldest old dying from COVID-19 in the acute hospital: A multicenter study describing pharmacological treatment in the last 24 h</title><title>Zeitschrift für Gerontologie und Geriatrie</title><addtitle>Z Gerontol Geriat</addtitle><addtitle>Z Gerontol Geriatr</addtitle><description>Background
Coronavirus disease 2019 (COVID-19) has a high mortality, especially in the oldest old. Dying from COVID-19 is often characterized by symptoms such as breathlessness and agitation but data concerning medical treatment in the dying phase are limited.
Objective
This study describes the administration of oxygen, opioids and benzodiazepines in the last 24 h before death in patients 80 years or older dying from COVID-19 on acute hospital wards.
Material and methods
In this multi-centric retrospective study, patients, 80 years and older, admitted to the acute hospital in March and April 2020 were recruited from 10 acute Belgian hospitals. They all were diagnosed with COVID-19 and died on non-ICU wards with COVID-19. Administration of oxygen, opioids and benzodiazepines in the last 24 h before death was registered.
Results
Eighty-five percent of patients received oxygen, half of them even by means of a mask providing at least 10l oxygen per minute. The majority (84.3%) of patients were treated with opioids (morphine). Mean dosage of SC morphine equivalent was 31.3 mg/24 h (range 2–120 mg; SD 21.6 mg). More than half of patients (52.8%) received benzodiazepines, mostly midazolam. Mean dosage of midazolam was 20.4 mg/24 h (range 1–100 mg; SD 15.4 mg). Dosages of morphine and midazolam did not differ depending on frailty or comorbidities. Older COVID-19 patients dying with respiratory failure had higher midazolam dosage (
p
0.002) but not morphine dosage (
p
0.11).
Conclusion
A high proportion of patients 80 years and older and dying with COVID-19 in the hospital, were treated with oxygen, opioids and benzodiazepines in the last 24 h before death. With this descriptive study, we hope to contribute to the discussion and further research on the optimization of symptom control in an older population dying from/with COVID-19.</description><subject>Aged, 80 and over</subject><subject>Aging</subject><subject>COVID-19 - drug therapy</subject><subject>Geriatrics/Gerontology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Contributions</subject><subject>Retrospective Studies</subject><subject>SARS-CoV-2</subject><subject>Social Sciences</subject><subject>Terminal Care</subject><issn>0948-6704</issn><issn>1435-1269</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kD9PwzAQxS0EoqXwBRhQRpaA_-WcLEioFKhUqUthtZzYbVMlcbETpH57HFoqWBhON9y7d-9-CF0TfEcwFvceY5aRGFMaCjOI-QkaEs6SmFDITtEQZzyNQWA-QBfebzAmQgA5RwOWUM4F8CGaLIyry0ZVUaGcicomspU2vu1bpHdls4qWztbReP4-fYpJ1ivatYlU0bUmWlu_LVtVXaKzpaq8uTr0EXp7nizGr_Fs_jIdP87igiWsjSHHGRAmIBdKp0KnGJYpaJYoQSHVTCSK5TphwJWhXHNsMKSgslxpSgklbIQe9r7bLq-NLkzTOlXJrStr5XbSqlL-nTTlWq7sp0zTgIJBMLg9GDj70YU_ZV36wlSVaoztvKTAgHDepxwhupcWznrvzPJ4hmDZ85d7_jLwl9_8JQ9LN78DHld-gAcB2wt8GDUr4-TGdi7w9__ZfgEV-I81</recordid><startdate>20220301</startdate><enddate>20220301</enddate><creator>Janssens, Wim H.</creator><creator>Van Den Noortgate, Nele J.</creator><creator>Piers, Ruth D.</creator><general>Springer Medizin</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20220301</creationdate><title>Terminal care in oldest old dying from COVID-19 in the acute hospital</title><author>Janssens, Wim H. ; Van Den Noortgate, Nele J. ; Piers, Ruth D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-6b0961376b7ad87d806f86d35a7268d375a3bd5364ae24d40e0686a9bad221213</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged, 80 and over</topic><topic>Aging</topic><topic>COVID-19 - drug therapy</topic><topic>Geriatrics/Gerontology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Contributions</topic><topic>Retrospective Studies</topic><topic>SARS-CoV-2</topic><topic>Social Sciences</topic><topic>Terminal Care</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Janssens, Wim H.</creatorcontrib><creatorcontrib>Van Den Noortgate, Nele J.</creatorcontrib><creatorcontrib>Piers, Ruth D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Zeitschrift für Gerontologie und Geriatrie</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Janssens, Wim H.</au><au>Van Den Noortgate, Nele J.</au><au>Piers, Ruth D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Terminal care in oldest old dying from COVID-19 in the acute hospital: A multicenter study describing pharmacological treatment in the last 24 h</atitle><jtitle>Zeitschrift für Gerontologie und Geriatrie</jtitle><stitle>Z Gerontol Geriat</stitle><addtitle>Z Gerontol Geriatr</addtitle><date>2022-03-01</date><risdate>2022</risdate><volume>55</volume><issue>2</issue><spage>129</spage><epage>134</epage><pages>129-134</pages><issn>0948-6704</issn><eissn>1435-1269</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Background
Coronavirus disease 2019 (COVID-19) has a high mortality, especially in the oldest old. Dying from COVID-19 is often characterized by symptoms such as breathlessness and agitation but data concerning medical treatment in the dying phase are limited.
Objective
This study describes the administration of oxygen, opioids and benzodiazepines in the last 24 h before death in patients 80 years or older dying from COVID-19 on acute hospital wards.
Material and methods
In this multi-centric retrospective study, patients, 80 years and older, admitted to the acute hospital in March and April 2020 were recruited from 10 acute Belgian hospitals. They all were diagnosed with COVID-19 and died on non-ICU wards with COVID-19. Administration of oxygen, opioids and benzodiazepines in the last 24 h before death was registered.
Results
Eighty-five percent of patients received oxygen, half of them even by means of a mask providing at least 10l oxygen per minute. The majority (84.3%) of patients were treated with opioids (morphine). Mean dosage of SC morphine equivalent was 31.3 mg/24 h (range 2–120 mg; SD 21.6 mg). More than half of patients (52.8%) received benzodiazepines, mostly midazolam. Mean dosage of midazolam was 20.4 mg/24 h (range 1–100 mg; SD 15.4 mg). Dosages of morphine and midazolam did not differ depending on frailty or comorbidities. Older COVID-19 patients dying with respiratory failure had higher midazolam dosage (
p
0.002) but not morphine dosage (
p
0.11).
Conclusion
A high proportion of patients 80 years and older and dying with COVID-19 in the hospital, were treated with oxygen, opioids and benzodiazepines in the last 24 h before death. With this descriptive study, we hope to contribute to the discussion and further research on the optimization of symptom control in an older population dying from/with COVID-19.</abstract><cop>Heidelberg</cop><pub>Springer Medizin</pub><pmid>35244764</pmid><doi>10.1007/s00391-022-02036-4</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Zeitschrift für Gerontologie und Geriatrie, 2022-03, Vol.55 (2), p.129-134 |
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| subjects | Aged, 80 and over Aging COVID-19 - drug therapy Geriatrics/Gerontology Hospitals Humans Internal Medicine Medicine Medicine & Public Health Original Contributions Retrospective Studies SARS-CoV-2 Social Sciences Terminal Care |
| title | Terminal care in oldest old dying from COVID-19 in the acute hospital: A multicenter study describing pharmacological treatment in the last 24 h |
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