Beyond hospice: the burden of palliative care needs in hospitals and long-term care facilities. A nationwide multicenter study.

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

Published in

Aging clinical and experimental research. Jun 28, 2026. Epub Jun 28, 2026.

Abstract

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.
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.
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.
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.

PMID:
42366281
Bibliographic data and abstract were imported from PubMed on 29 Jun 2026.

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