https://doi.org/10.4081/gc.2026.15807
56 | Utility of NECPAL tool in identifying palliative care needs in an acute geriatric ward: a 2-year survival analysis
B. Righi, L. Luppi, L. Feltri, J. Usai, R. Boni, M. Bertolotti, C. Mussi | Università degli Studi di Modena e Reggio-Emilia, Modena.
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Published: 11 June 2026
Introduction. Acute geriatric patients often present with advanced chronic conditions and complex needs requiring a proactive palliative approach. The Necesidades Paliativas (NECPAL) tool, centered on the "Surprise Question" (SQ), identifies patients at risk of death who may benefit from palliative care planning.
Objectives. To evaluate the NECPAL-SQ in predicting long-term prognosis and guiding clinical decisions, such as pharmacological optimization and palliative care activation, in hospitalized older adults.
Materials and Methods. A prospective observational study was conducted on 150 consecutive patients (mean age 84.7± 6.4 years, 49% women) admitted to the Acute Geriatric Ward of Baggiovara Civil Hospital (Modena, Italy) between January 1 and March 31, 2023. The NECPAL tool and Comprehensive Geriatric Assessment (CGA) was completed for all patients. 24-month survival was analyzed using Kaplan-Meier curves and multivariate Cox model.
Results. The Surprise Question (SQ-NO: "I would not be surprised if the patient died") identified 49.3% (74/150) of the sample as high-risk. This group showed significantly higher frailty (p<0,001): ADL (1.8 vs 3.8), Multi Prognostic Index (2.7 vs 2.0), and Clinical Frailty Scale (7.3 vs 5.5). SQ-NO patients received higher doses of morphine (90% vs 37%, p<0.001) and showed 100% sensitivity for in-hospital mortality. Kaplan-Meier analysis revealed a median survival of 4 months for SQ-NO vs. median survival not reached for SQ-YES (Log-Rank p<0.001). In the multivariate Cox model, the Clinical Frailty Scale was the strongest independent predictor of mortality (HR 1.95; 95% CI 1.37-2.77; p<0.001). Significant deprescribing of preventive drugs (statins, ACE-inhibitors) occurred in palliative patients.
Conclusions. The NECPAL Surprise Question is a reliable prognostic tool in acute care geriatrics. It effectively identifies high-risk patients, facilitating timely palliative care and appropriate deprescribing.
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