Palliative care consults for the oldest-old: A retrospective study of referral patterns, patient characteristics, and clinical outcomes.

OBJECTIVE: This study describes the characteristics and outcomes of patients aged 90 and older (the oldest-old) receiving inpatient palliative care consultation at a tertiary care hospital, to identify gaps and opportunities to improve care. METHODS: A retrospective review was conducted of 735 palliative care consultations for patients aged ≥90 between 2018 and 2022. Data on demographics, diagnosis, performance status, referral timing, and disposition were analyzed using descriptive statistics. RESULTS: The majority of patients (74%) had a non-malignant primary diagnoses, and only 7% had prior palliative care involvement. Most (74.1%) had severe functional impairment (Palliative Performance Scale ≤30%) at consultation. The median time from hospital admission to palliative care consult was four days, and the median time from consult to death or discharge was also four days. Ultimately, 64.6% of patients died in the acute care hospital or were transferred to a palliative care unit for end-of-life care. At the time of consultation, 88.2% had a Do Not Resuscitate order. CONCLUSION: Referrals for specialist palliative care in the oldest-old occur late in hospitalization, predominantly among those with non-cancer illnesses and poor functional status. Systemic changes, including the use of prognostication tools and enhanced collaboration between geriatric and palliative care services, are needed. Nurses are pivotal in advocating for earlier advance care planning (ACP) and identifying patients who would benefit from timely palliative integration to ensure goal-concordant care.