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Publications

Journal Article Ahead of print

PubMed: 42366281 DOI: 10.1007/s40520-026-03445-w

Beyond hospice: the burden of palliative care needs in hospitals and long-term care facilities. A nationwide multicenter study.

Aging Clin Exp Res

Authors: Graziano Onder, Alberto Zucchelli, Alba Malara, Gilda Borselli, Angela Iurlaro, Claudia Bauco, Angelo Bianchetti, Christian Bracco, Carmine Cafariello, Stefania Cartesio, Luca Cipriani, Giulia Deias, Diego De Leo, Elisa Durante, Gianpaolo Fortini, Fabio Gilioli, Stefania Giordano, Guido Horn, Myriam Macaluso, Lorenzo Palleschi, Elena Pinardi, Claudio Santini, Gianlorenzo Scaccabarozzi, Roberto Tarquini, Monica Torrini, Edoardo Varratta, Nicola Veronese, Maria Beatrice Zazzara, Dario Leosco, Giuseppe Bellelli

Affiliations

  • Università Cattolica del Sacro Cuore, Rome, Italy.
  • Fondazione Policlinico Gemelli IRCCS, Rome, Italy.
  • University of Brescia, Brescia, Italy.
  • Fondazione ANASTE Humanitas, Rome, Italy.
  • Società Italiana di Gerontologia e Geriatria, Florence, Italy.
  • Università Cattolica del Sacro Cuore, Rome, Italy.
  • Fondazione Policlinico Gemelli IRCCS, Rome, Italy.
  • ASL Frosinone, Frosinone, Italy.
  • Fondazione Teresa Camplani, Domus Salutis Brescia, Brescia, Italy.
  • Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy.
  • Provincia Romana Camilliani, Viterbo,, Italy.
  • ASL Roma 1, Rome, Italy.
  • Fondazione Sanità e Ricerca, Rome, Italy.
  • Griffith University, Gold Coast, Australia.
  • De Leo Fund, Padova, Italy.
  • Primorska University, Koper, Slovenia.
  • Gemelli Medical Center, Rome, Italy.
  • ASST Sette Laghi, Varese, Italy.
  • Ospedale S. Maria Bianca, AUSL Modena, Mirandola, MO, Italy.
  • RSA Salus, Fondazione ANASTE Humanitas, Rome, Italy.
  • Fondazione Antea, Rome, Italy.
  • Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy.
  • Centro Studi Medicina della Complessità e Cure Palliative, Milano-Bicocca University, Monza, Italy.
  • Grassi Hospital, ASL Roma 3, Rome, Italy.
  • USL Toscana Centro, Empoli, FI, Italy.
  • University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
  • Faculty of Medicine, Saint Camillus University, Rome, Italy.
  • Unità Locale Socio Sanitaria 3 Serenissima, Venice, Italy.
  • Università degli Studi di Napoli Federico II, Naples, Italy.
  • Fondazione IRCCS San Gerardo, Monza, Italy.

Abstract

INTRODUCTION

Palliative care is traditionally associated with hospice and cancer care, yet older adults admitted to hospitals and long-term care facilities (LTCF) frequently experience multimorbidity, frailty, and high symptom burden. We aimed to estimate the prevalence and characteristics of palliative care needs in Internal Medicine and Geriatrics hospital wards and LTCF in Italy.

METHODS

We conducted a national cross-sectional point-prevalence study. Adults aged ≥ 18 years hospitalized in participating wards or residing in LTCF were eligible. NECPAL 4.0 tool was used to identify patients and residents with palliative care needs. Additional indicators included functional and nutritional decline, repeated hospitalizations, dysphagia, pressure ulcers, delirium, and pain.

RESULTS

A total of 5,389 participants were included (3,303 hospital patients, median age 81 years; 2,086 LTCF residents, median age 86 years) from 235 facilities. Overall, 58.3% of hospitalized patients and 48.1% of LTCF residents had a positive NECPAL assessment. Prevalence was higher among patients with cancer (77.2% in hospital; 61.5% in LTCF), but remained substantial among those without cancer (50.8% in hospital; 46.8% in LTCF). Functional decline (56.2% hospital; 48.7% LTCF), nutritional decline (36.6%; 23.9%), dysphagia (17.6%; 28.8%), delirium (19.2%; 36.4%), and moderate-to-severe pain (25.9%; 20.3%) were common across settings.

CONCLUSION

Palliative care needs are highly prevalent among hospitalized patients and LTCF residents and are not limited to oncology. These findings support systematic screening and integration of a needs-based palliative care approach within hospital and long-term care systems.

MeSH

Long-Term Care, Delirium, Pain, Aging, Neoplasms, Prevalence, Deglutition Disorders, Palliative Care, Hospices