BACKGROUND: It is important to pursue goal-concordant care and to prevent non-beneficial interventions in older people. AIM: To describe serious illness communication and decision-making practices in hospitalised older people in Europe. SETTING/PARTICIPANTS: Data on advance directives, goals of care (GOC) discussions and treatment limitation decisions were collected about patients aged 75-years and older admitted to 23 European acute geriatric units (AGUs). RESULTS: In this cohort of 590 older persons [59.5% aged 85 and above, 59.3% female, median premorbid Clinical Frailty Score (CFS) 6], a formal advance directive was recorded in 3.3% and a pre-hospital treatment limitation in 14.0% with significant differences between European regions (respectively P < 0.001 and P = 0.018).Most prevalent GOC was preservation of function (46.8%). GOC were discussed with patients in 64.0%, with families in 73.0%, within the interprofessional hospital team in 67.0% and with primary care in 13.4%. The GOC and the extent to which it was discussed differed between European regions (both P < 0.001). The prevalence of treatment limitation decisions was 53.7% with a large difference within and between countries (P < 0.001). The odds of having a treatment limitation decision were higher for patients with pre-hospital treatment limitation decisions (OR 39.1), residing in Western versus Southern Europe (OR 4.8), belonging to an older age category (OR 3.2), living with a higher number of severe comorbidities (OR 2.2) and higher premorbid CFS (OR 1.3). CONCLUSIONS: There is large variability across European AGUs concerning GOC discussions and treatment limitation decisions. Sharing of information between primary and hospital care about patient preferences is noticeably deficient.

Cliniques Universitaires Saint Luc Avenue Hippocrate 10 1200 Bruxelles Belgium

Division of Palliative Medicine Rehabilitation and Geriatrics University Hospital Geneva and University of Geneva 11 ch de la Savonnière 1245 Collonge Bellerive Switzerland

Geriatric Medicine Oslo University Hospital Postboks 4950 Nydalen 0424 Oslo Norway

Geriatric Medicine University Hospital Ghent C Heymanslaan 10 9000 Gent Belgium

GGZ Geriatric Hospital Graz Albert Schweitzer Gasse 36 8020 Graz Austria

Hospice Haus Omega and Longterm Care Facilities 13 rue Prince Jean L 9052 Ettelbruck Grand Duchy of Luxembourg

Hospital Universitario Ramon y Cajal Carretera de Colmenar Viejo Km 9 100 28034 Madrid Spain

Institute of Health and Society UCLouvain Clos Chapelle aux champs 30 1200 Brussels Belgium

Internal Medicine and Gerontology Jagiellonian University Hospital in Krakow Macieja Jakubowskiego 2 30 688 Krakow Poland

Internal Medicine Ege University Faculty of Medicine Kazimdirik Universite Cd No 9 35100 Bornova Izmir Turkiye

Internal Medicine Erasmus Medical Center Dr Molewaterplein 40 3015 GD Rotterdam Netherlands

Universidade de Lisboa Avenida Professor Egas Moniz 1649 028 Lisboa Portugal

University Hospital Hradec Kralove Hradec Kralove Sokolska 581 500 05 Královéhradecký Czech Republic

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