Symptom Relief Is Possible in Elderly Dying COVID-19 Patients: A National Register Study.

Abstract

<b><i>Background:</i></b> Increasing numbers of people dying from COVID-19 are reported, but data are lacking on the way they die. <b><i>Objective:</i></b> To study symptoms and symptom relief during the last week of life, comparing nursing homes with hospitals. <b><i>Design:</i></b> The Swedish Register of Palliative Care with national coverage was used. Breakthrough symptoms were registered as Yes/No. Symptom relief was recorded on a 3-grade scale as <i>complete-partial-no relief</i>. All deaths in COVID-19 were contrasted to deaths in a reference population (deaths 2019). Deaths at nursing homes were compared with deaths in hospitals. <b><i>Setting and Subjects:</i></b> All deaths in hospitals or nursing homes (<i>n</i> = 490) were analyzed. Deaths in other settings (specialized palliative care wards [<i>n</i> = 11], in palliative home care [<i>n</i> = 2], or in their own homes [<i>n</i> = 8]) were excluded (<i>n</i> = 21). Only patients with expected deaths (<i>n</i> = 390) were entered in the final analysis. <b><i>Results:</i></b> Breathlessness as a breakthrough symptom was more common in COVID-19 patients than in the 2019 reference population (<i>p</i> < 0.001) and relief of breathlessness, as well as anxiety, delirium, and death rattles was less successful in COVID-19 patients (<i>p</i> < 0.05 to <i>p</i> < 0.01 in different comparisons). Patients were older in nursing homes than in hospitals (86.6 years vs. 80.9 years, <i>p</i> < 0.001) and more often female (48% vs. 34%, <i>p</i> < 0.001). Breakthrough of breathlessness was much more frequently reported in hospital settings than in nursing homes, 73% versus 35% (<i>p</i> < 0.0001), and complete relief was more rarely possible in hospitals, 20% versus 42% (<i>p</i> < 0.01). The proportion of partial relief+complete relief was comparable, 92% versus 95% (ns). Also, anxiety and pain were more often completely relieved in nursing homes (<i>p</i> < 0.01 in both comparisons). <b><i>Conclusion:</i></b> The lower symptom prevalence in nursing homes may be explained by elderly frail residents dying already in the first phase of the COVID-19 disease, before acute respiratory distress syndrome develops.