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Scandinavian Journal of Public Health, Vol. 36, No. 2, 177-182 (2008)
DOI: 10.1177/1403494807085375
© 2008 Associations of Public Health in the Nordic Countries Regions

Clinical problems at the end of life in a Swedish population, including the role of advancing age and physical and cognitive function

Eva Jakobsson

Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden, School of Life Sciences, University of Skövde, Skövde, Sweden, eva.jakobsson{at}gu.se

Fannie Gaston-Johansson

Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden, Johns Hopkins School of Nursing, Baltimore, Maryland, USA

Joakim Öhlén

Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden

Ingrid Bergh

School of Life Sciences, University of Skövde, Skövde, Sweden

Aims: To improve the understanding of specific clinical problems at the end of life, including the role of advancing age, physical function and cognitive function. Methods: The study is part of an explorative survey of data relevant to end-of-life healthcare services during the last 3 months of life of a randomly selected sample of the population of a Swedish county. Data were selected through retrospective reviews of death certificates and medical records, and comprise information from 12 municipalities and 229 individuals. Results: A range of prevalent concerns was found. Overall deterioration, urinary incontinence, constipation, impaired skin integrity, anxiety and sleep disturbances were significantly associated with dependency on others for activities of daily living; pulmonary rattles and swallowing disturbances were associated with cognitive disorientation; excepting cough, advancing age did not have significant impacts on these prevalent clinical concerns. Conclusions: A range of distressing conditions constitute a common pathway for many individuals at or near the end of life. The incorporation of health promotion as a principle of palliative care will probably benefit individuals at the end of life, and includes a proactive focus and emphasis on enhanced well-being at the time of diagnosis of a life-threatening illness. For individuals with physical and cognitive limitations imparting a state of dependency, it is reasonable to provide assurance of care for individuals' specific needs by professionals with both training for and competence in this special and sometimes unique clinical environment.

Key Words: Clinical problems • end of life • health promotion • palliative care • survey • symptoms


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