Palliative care for frail housebound patients
L. Hentsch1, C. Pereira1, N. Pinon1, S. Pautex1 (1Genève)
The early introduction of palliative care can have a positive impact on the quality of life of patients suffering from life limiting diseases. However, the palliative care needs of elderly, frail, housebound patients are still mostly unknown, as are the impact of frailty on the importance of these needs.
To identify frailty and the palliative care needs of elderly housebound patients in the community.
We conducted a cross-sectional observational study of patients that were ≥65 years old, housebound, followed by a geriatric community unit of the Geneva University Hospital.
Of the 232 patients deemed eligible, 73 patients were included in the study. Most patients were female (56.9%) and mean age(SD) was 81.1(±7.9). Edmonton Frail Scale at entrance identified patients as being mostly vulnerable (37%) and mildly frail (31.5%). The Edmonton Symptom Assessment Scale score was higher in mild, moderate and severely frailed patients as opposed to vulnerable patients for tiredness (mean±SD: 3.88±3.16 vs 2.07±2.73, p=0.016), drowsiness (2.45±2.37 vs 1.15 ±1.41, p=0.0196), loss of appetite (2.20±2.82 vs 0.70±1.64, p=0.0124) and feeling of wellbeing (3.73±2.21 vs 2.39±2.60 p=0.0132). There was no difference in the FACIT-Sp total score or in the subgroups of the FACIT-Sp between the vulnerable and frail groups. Although only 44% of enrolled patients had a caregiver willing to participate in the study, the overall burden on the caregiver measured by the MINI-ZARIT was low (2.12 ±1.49).
Elderly, fragile, housebound patients have palliative care needs that should be addressed. Moreover, these needs increase with the level of frailty.