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

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.

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Journal
Aging Clinical and Experimental Research
Published
2026-06-28
DOI
https://doi.org/10.1007/s40520-026-03445-w
Primary Topic
Palliative Care and End-of-Life Issues
Type
article
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article

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

Luca Cipriani, Fabio Gilioli, Claudia Bauco, Gianlorenzo Scaccabarozzi et al.
Aging Clinical and Experimental Research
Palliative Care and End-of-Life Issues
article

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

Luca Cipriani, Fabio Gilioli, Claudia Bauco, Gianlorenzo Scaccabarozzi, M. Torrini, Stefania Cartesio, Alberto Zucchelli, Carmine Cafariello, Graziano Onder, Dario Leosco, Lorenzo Palleschi, Elisa Durante, Maria Beatrice Zazzara, Angelo Bianchetti, Roberto Tarquini, Alba Malara, Gilda Borselli, Giulia Deias, Elena Pinardi, Claudio Santini, Angela Iurlaro, Edoardo Varratta, Myriam Macaluso, Palliative Care Day 2025 Working Group, Diego De Leo, Gianpaolo Fortini, Nicola Veronese, Christian Bracco, Guido Horn, Stefania Giordano, Giuseppe Bellelli
article en

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.

Aging Clinical and Experimental Research
Università Cattolica del Sacro Cuore (IT), Griffith University (AU), University of Primorska (SI), Università degli Studi della Tuscia (IT), Azienda Ospedaliera San Giovanni Addolorata (IT), Fondazione Roma (IT), Agostino Gemelli University Polyclinic (IT), Accademia di Belle Arti di Frosinone (IT), Azienda Unita' Sanitaria Locale Di Modena (IT), ASL Roma (IT), Società Italiana di Cardiologia (IT), Saint Camillus International University of Health and Medical Sciences (IT), Azienda Sanitaria Locale Viterbo (IT), Azienda Ospedaliera San Gerardo (IT), Azienda Ospedaliero-Universitaria Careggi (IT), ANT Foundation Italy Onlus (IT), Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo (IT), Fondazione Humanitas per la Ricerca (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Azienda Usl Toscana Centro (IT), Azienda Sanitaria Locale Roma 3 (IT), Aziende Socio Sanitarie Territoriale dei Sette Laghi, University of Florence (IT), University of Milano-Bicocca (IT), University of Naples Federico II (IT), University of Brescia (IT)
Università Cattolica del Sacro Cuore
Zero hunger
Openalex Percentile: Top 6%
Palliative Care and End-of-Life Issues
DOIOpen Access PDFOpenAlex
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