Quality of primary palliative care for older people with mild and severe dementia: an international mortality follow-back study using quality indicators.


Authors: Rose Miranda, Yolanda W H Penders, Tinne Smets, Luc Deliens, Guido Miccinesi, Tomás Vega Alonso, Sarah Moreels, Lieve Van den Block

Age and ageing (2018)


measuring the quality of primary palliative care for older people with dementia in different countries is important to identify areas where improvements can be made.


using quality indicators (QIs), we systematically investigated the overall quality of primary palliative care for older people with dementia in three different countries.


a mortality follow-back survey through nation- and region-wide representative Sentinel Networks of General Practitioners (GPs) in Belgium, Italy and Spain. GPs registered all patient deaths in their practice. We applied a set of nine QIs developed through literature review and expert consensus.


patients aged 65 or older, who died non-suddenly with mild or severe dementia as judged by GPs (n = 874).


findings showed significantly different QI scores between Belgium and Italy for regular pain measurement (mild dementia: BE = 44%, IT = 12%, SP = 50% | severe dementia: BE = 41%, IT = 9%, SP = 47%), acceptance of approaching death (mild: BE = 59%, IT = 48%, SP = 33% | severe: BE = 41%, IT = 21%, SP = 20%), patient-GP communication about illness (mild: BE = 42%, IT = 6%, SP = 20%) and involvement of specialised palliative services (mild: BE = 60%, IT = 20%, SP = 77%). The scores in Belgium differed from Italy and Spain for patient-GP communication about medical treatments (mild: BE = 34%, IT = 12%, SP = 4%) and repeated multidisciplinary consultations (mild: BE = 39%, IT = 5%, SP = 8% | severe: BE = 36%, IT = 10%, SP = 8%). The scores for relative-GP communication, patient death outside hospitals and bereavement counselling did not differ between countries.


while the countries studied differed considerably in the overall quality of primary palliative care, they have similarities in room for improvement, in particular, pain measurement and prevention of avoidable hospitalisations.

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