Significant changes in the terminal care of aged patients in the long-term care in Helsinki

Elderly patients (> or = 65 y) admitted to permanent institutional care in 1976 (n = 116) and 1985 (n = 193) in the city of Helsinki, Finland, were analyzed retrospectively in order to evaluate changes in the terminal care of aged patients. Patients were more demented and needed more care in 1985 than 1976. Decisions of "do not treat actively" (= NTA) increased from 16% to 39% for all patients and 18% vs 42% in patients not transferred. Laboratory examinations, parenteral treatment as well as antibiotic treatments in febrile patients during the last 7 days decreased even after controlling for dementia and functioning, but transfers to other institutions remained unchanged. The survey demonstrates that the terminal care has changed significantly as recommended in the guidelines.