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Context Although dying peacefully is considered an important outcome of high-quality palliative care, large-scale quantitative research on dying peacefully and the factors associated with a peaceful death is lacking. Objectives To gain insight into how many residents with dementia in long-term care facilities die peacefully, according to their relatives, and whether that assessment is correlated with observed physical and psychological distress. Methods This was a retrospective cross-sectional study of deceased nursing home residents in a representative sample of long-term care facilities in Flanders, Belgium (2010). Structured post-mortem questionnaires were completed by relatives of the resident, who were asked to what extent they agreed that the resident “appeared to be at peace” during the dying process. Spearman correlation coefficients gave the correlations between physical and psychological distress (as measured using the Symptom Management at the End of Life with Dementia and Comfort Assessment in Dying at the End of Life with Dementia scales) and dying peacefully (as measured using the Quality of Dying in Long Term Care instrument). Results The sample comprised 92 relatives of deceased residents with dementia. In 54% of cases, relatives indicated that the resident died peacefully. Weak-to-moderate correlations (0.2–0.57) were found between dying peacefully and physical distress in the last week of life. Regarding psychological distress, weak-to-moderate correlations were found for both the last week (0.33–0.44) and last month of life (0.28–0.47). Conclusion Only half of the residents with dementia died peacefully as perceived by their relatives. Relatives' assessment of whether death was peaceful is related to both physical and psychological distress. Further qualitative research is recommended to gain more in-depth insights into the aspects on which relatives base their judgment of dying peacefully. [ABSTRACT FROM AUTHOR]

Background: Dying at home and dying at the preferred place of death are advocated to be desirable outcomes of palliative care. More insight is needed in their usefulness as quality indicators. Our objective is to describe whether “the percentage of patients dying at home” and “the percentage of patients who died in their place of preference” are feasible and informative quality indicators. Methods and Findings: A mortality follow-back study was conducted, based on data recorded by representative GP networks regarding home-dwelling patients who died non-suddenly in Belgium (n = 1036), the Netherlands (n = 512), Italy (n = 1639) or Spain (n = 565). “The percentage of patients dying at home” ranged between 35.3% (Belgium) and 50.6% (the Netherlands) in the four countries, while “the percentage of patients dying at their preferred place of death” ranged between 67.8% (Italy) and 86.0% (Spain). Both indicators were strongly associated with palliative care provision by the GP (odds ratios of 1.55–13.23 and 2.30–6.63, respectively). The quality indicator concerning the preferred place of death offers a broader view than the indicator concerning home deaths, as it takes into account all preferences met in all locations. However, GPs did not know the preferences for place of death in 39.6% (the Netherlands) to 70.3% (Italy), whereas the actual place of death was known in almost all cases. Conclusion: GPs know their patients’ actual place of death, making the percentage of home deaths a feasible indicator for collection by GPs. However, patients’ preferred place of death was often unknown to the GP. We therefore recommend using information from relatives as long as information from GPs on the preferred place of death is lacking. Timely communication about the place where patients want to be cared for at the end of life remains a challenge for GPs. [ABSTRACT FROM AUTHOR]

Evidence based guidelines for treatment of physical symptoms during the last days of life in older people are not available.We wanted to synthesize the existing evidence on the pharmacological treatment of pain, dyspnea, death rattle, fever, nausea, and vomiting during the last days of life in older people to develop recommendations that can help guide clinical practice.A systematic review was conducted (PROSPERO #CRD42023406100) and reported in accordance with PRISMA guidelines.MEDLINE and EMBASE were searched from inception till March 2023, together with national and international guideline databases.Four predominantly descriptive studies on opioid use were included for the treatment of pain and four for dyspnea, without clear evidence for the choice of one specific opioid, nor a specific opioid dose. For death rattle, five randomized controlled trials and two retrospective studies were included. These provide evidence for the prophylactic treatment of death rattle with hyoscine butylbromide. For fever, nausea, and vomiting, no articles met the inclusion criteria.Limited evidence exists to guide the pharmacological treatment of pain, dyspnea, death rattle, fever, nausea, and vomiting in the last days of life of older people. Other than the use of opioids for treatment of pain and dyspnea and prophylactic administration of hyoscine butylbromide to decrease the likelihood of developing death rattle, no specific recommendations can be formulated for use in clinical practice. This demonstrates the challenging nature of research in the last days of life of older people, despite its pressing need. [ABSTRACT FROM AUTHOR]

Background and Objective: Death rattle (DR) is a common symptom in dying patients, caused by secretions in the upper airway. Experiences regarding DR differ among patients, relatives, and health professionals. However, evidence of patients', relatives', and health professionals' needs for DR management in order to improve their experiences is lacking. In addition, little is known about the actual effects of non-pharmacological interventions on DR intensity or DR-related distress. This narrative review aims to explore (I) the experiences and needs of patients, relatives, and health professionals regarding DR sound and its management; and (II) studies on non-pharmacological interventions in DR management., Methods: Based on a PubMed literature search with the free-text term "death rattle", nine studies published in the last ten years were included., Key Content and Findings: No significant correlation between DR intensity and patients' respiratory distress could be found. Some relatives experience high levels of distress and express a need for DR care improvement. Health professionals are often influenced in their decision-making to intervene by external pressure or their need 'to do something'. Both repositioning and explaining DR to relatives are seen as useful first-line non-pharmacological interventions by health professionals. The severity of DR does not improve when suctioning is performed before starting anticholinergics., Conclusions: Variation in DR-related experiences and needs exists among relatives and health professionals. More research is needed into the effectiveness of non-pharmacological interventions for DR management and the most suitable measurement tools to objectify DR-related outcomes.