52 | Need for palliative care in nursing homes

A. Ranzenigo, M.G. Vitali, V. Bondì, A. Brunelli, P. Cagna, N. Eni, P. Grgorini, C. Uboldi, S. Mosconi | Fondazione Casa di Dio, Brescia.

Introduction. Nursing Homes (NHs) are shifting from primarily caring for frail and socially isolated older adults to increasingly serving people in the final phase of life, making it essential to develop end-of-life care competencies.

Materials and Methods. We analysed deaths between July 2023 and December 2025 in four NHs in Brescia (460 beds). Data are presented as absolute numbers, means ± SD, and percentages. Comorbidity was assessed using CIRS-G; cognitive function with MMSE; functional autonomy with Barthel Index; and gait performance with Tinetti Scale.

Results. A total of 387 deaths were recorded: 93 men (23.9%) and 294 women (76.1%). The mean age was 89.1 ± 4.56 years, with a mean comorbidity index of 4.1 ± 1.6. Mean MMSE was 7.84 ± 8.24, mean Barthel Index 12.0 ± 19.3, and mean Tinetti score 3.32 ± 6.14. Mean length of stay was 30 ± 29 months (2 days–15 years). The main causes of death were neurodegenerative diseases (41.6%), infections (pneumonia 12.1%, sepsis 6.2%), cardiovascular diseases (11.8%), cancer (8.7%), cerebrovascular diseases (3.4%), malnutrition (3.1%), and trauma (5.3%). Death occurred in the NHs in 88.4% of cases and in hospital in 11.6%. Terminal status was recognised in 72.4% of residents, and comfort therapy was provided in advance of death in 59.3%.

Conclusions. Deaths involved very old residents with severe cognitive and functional impairments and high comorbidity. Of 44 hospitalisations, only 12 were for conditions not manageable within the NHs; in the remaining cases, family pressure contributed to potentially inappropriate transfers, with death occurring within 72 hours. Multidimensional assessment enabled recognition of the terminal phase in most cases, supporting shared decision-making with families and adequate symptom control. As NHs increasingly care for very old individuals, often in the final year of life, the main goal of care becomes optimising the quality of remaining life through an early, structured palliative approach.