Assistenza di fine vita e cure palliative : l'esempio della Regione Toscana

This paper summarizes a research of the Regional Agency for Health in Tuscany (Florence, Italy) on end-of-life and palliative care. The evolving concepts and definitions at the international level as well as some relevant experiences of research and intervention are reported. The national context is described through recent legislation and the state-of-the art of health services. The experience of Tuscany is discussed with respect to regulation, health services and significant experiences in epidemiological research, education, and cultural promotion. The population needs for palliative care are estimated on the basis of mortality rates and hospital admissions in the last year of life. Seventy-five percent of people dying in 2003 had at least one hospital admission in the 12 previous months, while 42.1 percent of deaths occurred in hospital (more than half of them in Internal Medicine or Intensive Care Units).