Mortalidad en Medicina Interna. Importancia de los pacientes en situación terminal

Background and objectives: many patients with end-stage chronic illnesses are cared for in medical services, outside specific palliative care resources. This encouraged us to review the patients that had died in our department during 2006, describing their characteristics and the care they were given. Patients and methods: a retrospective descriptive study of the clinical records of patients who died during 2006 at Internal Medicine Service, Virgen de la Torre Hospital, Madrid, Spain. We analyzed their sociodemographic and clinical information, end-stage disease criteria, causes of death, type of care and treatments, degree of instrumentalization, and presence of a living will. The results were analyzed with the statistical program SPSS 14.0. Results: we obtained 172 clinical records of 188 deceased patients during this period (64.5% women, 35.5% males, mean age 85.76 ± 7.0); 69% of patients had end-stage disease, and diseases included dementia in 52%, cancer in 14%, COPD in 10%, and heart failure in 9%. Death was most commonly of respiratory (70%), neurological (52%), cardiovascular (35%), or septic (31%) cause. No patient had a living will; 81% of terminal patients were included in a palliative protocol. Conclusions: a high percentage of the patients that had died in our service had a terminal chronic disease. Patient type was a woman of advanced age, with multiple chronic diseases, with a high level of dependency, cared after by her family, and with end-stage dementia. No patient had a living will.