Palliative Care for Very Old Patients: A Three-Year Single-Center Retrospective Study

Background: Nonagenarians with advanced cancer represent a growing yet understudied population in specialist palliative care. Objectives: To describe clinical characteristics, symptom profiles, palliative interventions, and end-of-life outcomes among patients aged 90 years and older admitted to a specialist palliative care unit in Japan. Design: Three-year retrospective descriptive case series. Methods: All patients aged ≥ 90 years admitted to a 24-bed specialist palliative care unit in a municipal acute-care hospital in western Japan between April 2020 and March 2023 ( n = 71 of 684 total admissions, 10.4%). Demographics, primary cancer site, comorbidities, presenting symptoms, opioid and sedative use, delirium, length of stay, and discharge disposition were extracted from clinical records. Results: Comorbidities were present in 95.8% (mean 2.3 ± 1.1 per patient), dementia in 56.3%; fatigue and anorexia were the most frequently documented presenting symptoms (38.0% and 33.8%), and pain was the primary complaint in 2.8%. Delirium occurred in 31.0%; 93.0% died on the unit. Conclusions: Nonagenarians in specialist palliative care frequently have dementia and non-pain-predominant symptom profiles, underscoring the need for structured assessment of both pain and non-pain symptoms.