Dementia Patients' Medical Records Often Lack Identification of Last Days of Life

Strategic Insights -

A study published in the journal Palliative and Supportive Care found that more than one in four patient's medical records of dementia patients who presented to the Emergency Department within the last 7 days of their lives made no explicit reference to the identification of last days of life. The study, conducted at a university tertiary hospital in Porto, Portugal, used reflexive thematic analysis to review 2021 ED medical records of dementia patients. The researchers identified three broader themes: (I) diagnosis and prognosis concerning the last days or hours of life; (II) goals of care, medical decisions, and communication about care in the last days or hours of life; and (III) comfort and needs assessment in the last days of life.

Key Takeaways:

  • More than one in four patient's medical records (n = 55, 27.4%) made no explicit reference to the identification of last days of life.
  • Only 2 medical records contained the specific designation "last days of life".
  • The quality of ED medical records is relevant for better care in the last hours or days of life.
  • The identification of last days of life is a challenge in dementia patients.
  • Clinical notes are of poor-quality regarding communication and shared decision making.
  • The study highlights the need for better identification of last days of life in dementia patients.
  • The findings suggest that there is a need for improvement in communication and shared decision making in the last days of life.
  • The study's results have implications for the care of dementia patients in the Emergency Department.

Statistics:

  • 55 (27.4%) of 202 dementia patients' medical records made no explicit reference to the identification of last days of life.
  • 2 medical records contained the specific designation "last days of life".
  • 1 in 4 patient's medical records (n = 55 out of 202) did not explicitly mention the last days of life.

Sources:

  • "Reflexive thematic analysis of emergency department medical records of dementia patients regarding the identification of last days of life". Palliative and Supportive Care, 2025; 23.
  • Cambridge Univ Press, Edinburgh Bldg, Shaftesbury Rd, CB2 8RU Cambridge, England. (journals.cambridge.org/action/displayJournal?jid=PAX)