Beyond hospice: the burden of palliative care needs in hospitals and long-term care facilities. A nationwide multicenter study
Year: 2026
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: Palliative care is traditionally associated with hospice and cancer care, yet older adults admitted to hospitals and long-term care facilities (LTCF) frequently experience multimorbidity, frailty, and high symptom burden. We aimed to estimate the prevalence and characteristics of palliative care needs in Internal Medicine and Geriatrics hospital wards and LTCF in Italy. METHODS: We conducted a national cross-sectional point-prevalence study. Adults aged ≥ 18 years hospitalized in participating wards or residing in LTCF were eligible. NECPAL 4.0 tool was used to identify patients and residents with palliative care needs. Additional indicators included functional and nutritional decline, repeated hospitalizations, dysphagia, pressure ulcers, delirium, and pain. RESULTS: A total of 5,389 participants were included (3,303 hospital patients, median age 81 years; 2,086 LTCF residents, median age 86 years) from 235 facilities. Overall, 58.3% of hospitalized patients and 48.1% of LTCF residents had a positive NECPAL assessment. Prevalence was higher among patients with cancer (77.2% in hospital; 61.5% in LTCF), but remained substantial among those without cancer (50.8% in hospital; 46.8% in LTCF). Functional decline (56.2% hospital; 48.7% LTCF), nutritional decline (36.6%; 23.9%), dysphagia (17.6%; 28.8%), delirium (19.2%; 36.4%), and moderate-to-severe pain (25.9%; 20.3%) were common across settings. CONCLUSION: Palliative care needs are highly prevalent among hospitalized patients and LTCF residents and are not limited to oncology. These findings support systematic screening and integration of a needs-based palliative care approach within hospital and long-term care systems.
Authors: Graziano Onder, Alberto Zucchelli, Alba Malara, Gilda Borselli, Angela Iurlaro, Claudia Bauco, Angelo Bianchetti, Christian Bracco, Carmine Cafariello, Stefania Cartesio, Luca Cipriani, Giulia Deias, Diego De Leo, Elisa Durante, Gianpaolo Fortini, Fabio Gilioli, Stefania Giordano, Guido Horn, Myriam Macaluso, Lorenzo Palleschi, Elena Pinardi, Claudio Santini, Gianlorenzo Scaccabarozzi, Roberto Tarquini, Monica Torrini, Edoardo Varratta, Nicola Veronese, Maria Beatrice Zazzara, Dario Leosco, Giuseppe Bellelli, Palliative Care Day 2025 Working Group
Institutions: Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic, University of Brescia, Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo, ASL Roma, Griffith University, University of Primorska, Aziende Socio Sanitarie Territoriale dei Sette Laghi, Azienda Ospedaliera San Giovanni Addolorata, University of Milano-Bicocca, Azienda Sanitaria Locale Roma 3, Azienda Usl Toscana Centro, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Saint Camillus International University of Health and Medical Sciences, University of Naples Federico II
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,490
OpenAlex ID: W7166443711