Clinical profile of geriatric patients in the week before death: a cross-sectional study in a second-level hospital in Mexico

Erick I. Alonso-Meza, Department of Geriatrics, Hospital General Querétaro, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Santiago of Queretaro, Queretaro, Mexico
Martha I. Ramos-Mier, Department of Epidemiology, Hospital General Querétaro, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Santiago of Queretaro, Queretaro, Mexico
Enrique Villarreal-Ríos, Department of Epidemiology, Hospital General Querétaro, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Santiago of Queretaro, Queretaro, Mexico

Background: The final stage of life is characterized by progressive clinical deterioration, the timely recognition of which is essential to guide clinical decisions focused on the patient's quality of life. Evidence in Mexico is limited and influenced by sociodemographic, intercultural, normative, and structural factors, compared to the international literature. Objective: To describe the clinical profile of the patient, with emphasis on the frequency and progression of the main signs and symptoms in the final stage of life. Material and methods: A prospective cross-sectional observational study was conducted. Patients aged ≥ 60 years were included between December 2023 and October 2024, who met the completion criteria established in current national regulations. Patients with brain death and invasive or non-invasive mechanical ventilation were excluded. The sample was calculated using a formula for finite populations (n = 65). Signs and symptoms were recorded by daily observation. A descriptive analysis was performed with percentage estimation and 95% confidence intervals (CI). Results: 65 patients were included (mean age 77.1). The most frequent signs during the week prior to death were reduced intake (100%; 95% CI: 94.5-100), loss of functionality (96.9%; 95% CI: 89.3-99.6), edema (55.4%; 95% CI: 42.3-67.9), dyspnea (46.2%; 95% CI: 33.7-59.1) and pain (40.0%; 95% CI: 28.0-53.1). Conclusion: The correct identification of the clinical profile before death allows strengthening timely palliative decision-making, promoting care focused on the patient's dignity and quality of life.

Keywords: Palliative care. End-of-life stage. Terminal symptoms.