Differences in perceptions of quality of dying scores during the last days of life on Belgian acute geriatric wards: a prospective observational study in relatives, nurses, and doctors.

Biesbrouck T, Leleu M, Delporte M, Janssens W, Flamaing J, Van Den Noortgate N, Piers R, De Roo ML. Differences in perceptions of quality of dying scores during the last days of life on Belgian acute geriatric wards: a prospective observational study in relatives, nurses, and doctors. Eur Geriatr Med. 2026 Jul 30. doi: 10.1007/s41999-026-01564-1.

Purpose: This multicentre prospective observational study aimed to describe the evolution of pain and comfort during the last days of life in older people, comparing assessments by relatives, nurses, and doctors. Methods: Relatives, nurses and doctors of patients with an expected death, admitted to acute geriatric wards in two Belgian university hospitals, completed the End-of-Life in Dementia-Comfort Assessment in Dying scale (EOLD-CAD, range 14-42, higher scores indicating higher comfort) once per day. Pain scores were retrieved from medical charts. Linear mixed models assessed longitudinal evolutions and inter-rater correlations. 

Results: After the last days of life were recognised, median time until death of 103 included patients was 39.6 h. Nurses and doctors completed scales for 84 patients and relatives for 42. Doctors scored higher on the EOLD-CAD scale compared to relatives (+ 3.4, p = 0.005), with largest difference on the dying symptoms subscale. EOLD-CAD-scores increased over time for relatives (+ 1.2 per 24 h, p = 0.001). Compared to relatives, doctors' and nurses' scores increased 0.7 less (p = 0.09) and 1.1 less (p = 0.004) per 24 h, respectively. Patient level correlations were weak, with highest correlation between nurses and doctors (maximum r = 0.25, p = 0.005). All correlations with relatives were low and non-significant. 

Conclusion: Quality of dying scores improved over time. Perceptions evaluated with EOLD-CAD scale differ between relatives, nurses and doctors, particularly regarding dying symptoms. These results underscore the importance of timely and active communication to explore relatives' perspectives during the last days of life. 

Keywords: Geriatrics; Nurses; Palliative care; Quality of dying; Symptom burden; Terminal care. 

© 2026. The Author(s), under exclusive licence to European Geriatric Medicine Society.