Symptoms, symptom relief and support in COVID-19 patients dying in hospitals during the first pandemic wave

BMC Palliat Care. 2021 Jul 1;20(1):102. doi: 10.1186/s12904-021-00785-4.


Background: At the time of the first wave of the COVID-19 pandemic in Sweden, little was known about how effective our regular end-of-life care strategies would be for patients dying from COVID-19 in hospitals. The aim of the study was to describe and evaluate end-of-life care for patients dying from COVID-19 in hospitals in Sweden up until up until 12 November 2020.

Methods: Data were collected from the Swedish Register of Palliative Care. Hospital deaths during 2020 for patients with COVID-19 were included and compared to a reference cohort of hospital patients who died during 2019. Logistic regression was used to compare the groups and to control for impact of sex, age and a diagnosis of dementia.

Results: The COVID-19 group (1476 individuals) had a lower proportion of women and was older compared to the reference cohort (13,158 individuals), 81.8 versus 80.6 years (p < .001). Breathlessness was more commonly reported in the COVID-19 group compared to the reference cohort (72% vs 43%, p < .001). Furthermore, anxiety and delirium were more commonly and respiratory secretions, nausea and pain were less commonly reported during the last week in life in the COVID-19 group (p < .001 for all five symptoms). When present, complete relief of anxiety (p = .021), pain (p = .025) and respiratory secretions (p = .037) was more often achieved in the COVID-19 group. In the COVID-19 group, 57% had someone present at the time of death compared to 77% in the reference cohort (p < .001).

Conclusions: The standard medical strategies for symptom relief and end-of-life care in hospitals seemed to be acceptable. Symptoms in COVID-19 deaths in hospitals were relieved as much as or even to a higher degree than in hospitals in 2019. Importantly, though, as a result of closing the hospitals to relatives and visitors, patients dying from COVID-19 more frequently died alone, and healthcare providers were not able to substitute for absent relatives.

Keywords: COVID-19; Dementia; End-of-life care; Hospitals; Palliative care; Pandemic.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anxiety / epidemiology
  • Anxiety / virology
  • COVID-19 / complications*
  • COVID-19 / epidemiology*
  • COVID-19 / psychology
  • Cohort Studies
  • Delirium / epidemiology
  • Delirium / virology
  • Dyspnea / epidemiology
  • Dyspnea / virology
  • Female
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Nausea / epidemiology
  • Nausea / virology
  • Pain / epidemiology
  • Pain / virology
  • Palliative Care*
  • Registries
  • Sweden / epidemiology
  • Symptom Assessment
  • Terminal Care*
  • Young Adult