World-wide literature survey on geriatric palliative medicine

PurposeTo identify and describe studies regarding geriatric palliative medicine published in the last 5 years.MethodsElectronic searches were performed in June 2009. Characteristics of patients and intervention were considered as inclusion criteria. The studies included were classified by provenance, type, objective and disease category. Clinical and organisational topics were extracted.ResultsSearches yielded 5075 records; 404 individual papers were included. Provenance: North America 43.3%, Northern Europe 5.5%, British Isles 17.8%, Western Europe 14.4%, Eastern Europe 1%, Southern Europe 6.2%, Japan and Australia 7.15%, other 4.7%. Eighty papers per year were published in 178 different periodicals (1.5 papers/periodical). Type of studies: narrative reviews 12.1%, guidelines 4.5%, systematic reviews 3.2%, experimental studies 3.5%, expert opinions 17.6%, descriptive studies 29.0%, and observational studies 30.2%. Study objectives: intervention studies 47.8%, epidemiological studies 18.1%, and diagnostic studies 6.4%; 5.4% combined different objectives and 22.3% investigated other aspects of care. Disease category: advanced dementia 22.5%, cancer 21%, organ failure 12.1%, miscellaneous 44.3%. Forty-four topics were identified, the main ones being: end-of-life, psychology/spirituality, ethics, pain, age/ageism, symptom management, function/falls, organisation of care, nursing homes, palliative care, prescribing issues, quality, nursing, and education.ConclusionsPractical implications: as experimental data are lacking, clinicians and decision-makers must look to observational, descriptive and qualitative research which, in some cases, provides useful evidence. Implications for research: more experimental research is needed, though there are concerns regarding feasibility and acceptability. Alternatives to classical RCT should be considered. Editorial initiatives aimed at collecting research reports are desirable.