Background: Surviving sudden cardiac arrest often lead to long-term cognitive, emotional, and physical consequences. Although clinical guidelines recommend structured post-cardiac arrest follow-up, such follow-up is often lacking or inconsistent. Tailored digital interventions are scarce but may help address gaps in follow-up resources. The CARDIS trial evaluates the effects on patient-reported outcome measures of a co-created, web-based support programme designed to improve wellbeing, self management, and reintegration into everyday life for cardiac arrest survivors. Methods: CARDIS is a multicentre, parallel-group, randomised controlled trial enrolling cardiac arrest survivors aged >18 years. Participants will be randomised 1:1 to intervention or control. Both groups will receive standard post-cardiac arrest care, including a routine followup visit with screening and management of cognitive, physical and emotional health, as well as a printed booklet. The intervention group will additionally receive access to a webbased selfguided support programme for 3 months. After study completion, control participants will be offered the programme. Outcomes: Primary outcome is overall wellbeing and health (QWB) at 3 months. Secondary outcomes include self-reported cognitive problems, HRQoL, life satisfaction, symptoms of depression and anxiety, post-traumatic stress, fatigue, and sleep disturbances. A process evaluation will evaluate social selection bias, adherence and participants experiences. Discussion: The CARDIS trial will investigate the use of more accessible and standardised follow-up pathways by complementing existing care structures, thereby enhancing equity in long-term recovery and quality-of-life without requiring additional healthcare resources. The process evaluation will provide data on adherence, social selection, and engagement, essential for future implementation.Trial registration: The trial is registered at clinicaltrials.gov (NCT07240714).

Police Patrol Officers (PPOs) increasingly encounter individuals experiencing severe mental ill health who may pose a risk to themselves or others. In such situations, PPOs may act either independently or in collaboration with healthcare professionals, navigating a complex interplay between legal duties, safety considerations, and ethical responsibilities. This qualitative study aiming to explore PPOs’ ethical competence in such situations employed focus group interviews (n = 5) with PPOs (n = 32) and applied a deductive qualitative content analysis based on Lechasseur et al.’s framework of ethical competence, comprising ethical sensitivity, ethical knowledge, ethical reflection, ethical decision-making, ethical action, and ethical behaviour. The findings suggest that PPOs demonstrate several dimensions of ethical competence yet describe challenges related to emotional detachment, managing uncertainty, and balancing caregiving and law-enforcement responsibilities. Ethical competence was mainly articulated in relation to professional duty, harm reduction, and efforts to balance safety, autonomy, and support. The findings indicate a need for continued ethics education, structured opportunities for reflection, and strengthened interprofessional collaboration to support ethically grounded practice in encounters involving individuals experiencing severe mental ill health.

BACKGROUND: Discrimination and inequities in healthcare have gained increased attention worldwide. Although many healthcare systems strive to provide equal care, evidence indicates that treatment can be influenced by patient characteristics such as gender, age, race/ethnicity, and socioeconomic status. In particular, research exploring healthcare professionals’ perceptions on equality in acute, life-threatening conditions remains limited. This study aimed to describe Swedish healthcare professionals’ perceptions of unequal and equal care when treating patients with cardiac arrest. METHODS: The study adopted a qualitative inductive design, using semi-structured interviews with 12 physicians and nurses who work in acute care clinics in Sweden. Data were analysed using thematic analysis. RESULTS: The overarching theme, “Equal care under pressure—guided by principles, shaped by context”, captured how professionals perceive the provision of cardiopulonary resuscitation (CPR) during sudden cardiac arrest as fundamentally equal. CPR was described as an automatic, protocol-driven intervention offered to all patients, reinforcing the principle of equality and without any clear discrimination based on ethnicity, gender, or socioeconomic background. However, equality in practice was nuanced. Decision-making about CPR introduce ethical complexity, particularly for older patients from whom prognostic uncertainty and emotional factors could influence care. Team competence was critical for maintaining equity under pressure, while contextual factors such as location, cultural norms, and safety concerns could delay or complicate treatment. Finally, professionals emphasize the need for structured reflection, recognizing its role in learning and ethical decision-making. Together, these findings illustrate that while CPR was guided by principles of equal care, its delivery was shaped by clinical judgment, team dynamics, and situational realities. CONCLUSIONS: Healthcare professionals perceive cardiac arrest care as predominantly equal. However, subtle vulnerabilities challenge this perception. Older age emerged as the most influential factor in CPR decisions, raising concerns about potential ageism and the need for clearer Do Not Attempt Resuscitation (DNAR) criteria and patient involvement. Promoting equality requires team competence, structured reflection, and proactive communication about resuscitation preferences. Further research should examine age, multimorbidity, psychiatric illness, DNAR practices, and gender differences to strengthen equity in cardiac arrest care.

This commentary examines the methodological and practical implications of the Ethical Case Reflection sessions reported by Bennesved et al. (2025). We argue that Ethics Case Reflection offers a distinctive contribution to clinical ethics by surfacing both ethically desirable aspirations and problematic attitudes that shape everyday practice. By applying a qualitative descriptive design and conventional content analysis to the original session transcripts, we illustrate how Ethics Case Reflection functions not only as a tool for case-based deliberation but also as an ethics laboratory in which participants explore a broad spectrum of possibilities. We highlight the importance of skilled facilitation for recognizing moments of self-critical reflection, promoting specificity in recommended actions, and supporting attention to both patient-centred and organisational dimensions.

Background: Survivors of cardiac arrest often face multifaceted challenges-cognitive, emotional, physical, and existential- that extend beyond clinical recovery. Despite these long-term consequences, follow-up care is often insufficient, and access to reliable information and support remains limited. Broader initiatives to address post-cardiac arrest care are still lacking. This qualitative study represents the initial phase of a multiphase development process to cocreate, design, and later evaluate a web-based support and learning platform for cardiac arrest survivors. The platform is intended to complement existing health care services and support survivors in managing life after cardiac arrest. Objective: This study aimed to explore survivors' perspectives on digital support and identify relevant content and delivery formats for a web-based support and learning platform. Methods: Eight women and 12 men (aged 44-80 years) were recruited via a moderated peer support network for cardiac arrest survivors. Time since cardiac arrest ranged from 3 months to 19 years. Data were collected between November 2024 and February 2025 through 3 individual and 4 focus group interviews, analyzed using qualitative content analysis. Results: Three main categories-(1) digital communication and guided health care navigation, (2) digital opportunities to support recovery and address unmet needs, and (3) digital and interpersonal pathways to safe social contexts-were identified as key design requirements for digital support. Substantial gaps in post-cardiac arrest care emerged, including fragmented and sometimes contradictory information, regional disparities, and limited psychosocial follow-up, underscoring the value of a national, accessible, trustworthy web-based program that complements standard care throughout recovery. Flexible formats- such as short videos, read-aloud functions, and information available both as concise and more in-depth versions-were considered essential to accommodate fatigue and cognitive difficulties. A digital platform was further identified as uniquely suited to gather relevant information in one place, provide expert-based explanations and links to further resources, and offer practical tools that could be accessed at home. Across categories, several unmet needs emerged as particularly suited to digital delivery, including guidance on health and everyday decisions, support for managing emotional and physical aftermath,resources to navigate altered social relations, intimacy and personality changes, and dedicated support for family members, who often lack tailored and continuous follow-up. Conclusions: Findings underscore the need for a tailored digital support program that extends beyond clinical encounters and offers structured, accessible, and personalized guidance across the recovery trajectory. By addressing long-term cognitive, physical, emotional, and relational needs, a contextually adapted digital program has the potential to bridge existing gaps in post-cardiac arrest care and strengthen survivors' recovery. These user-driven insights provide a foundation for the cocreation and iterative development of a clinically grounded and adaptable digital support platform.

Importance:Health-related quality of life (HRQOL) follow-up can increase knowledge of cardiac arrest outcomes from the patient's perspective. Whether HRQOL affects long-term survival is unknown. Objective:To investigate whether HRQOL 3 to 6 months after cardiac arrest is associated with long-term survival. Design, Setting, and Participants:This cohort study linked 5 national registers with nationwide coverage in Sweden across a 7-year period and included survivors of in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) between January 1, 2014, and December 31, 2019, with follow-up through June 30, 2021. Participants were adults surviving at least 90 days after IHCA or OHCA who completed follow-up EuroQoL 5-dimension 5-level (EQ-5D-5L) tool questionnaires. Analyses were performed December 2 to 20, 2024. Exposures:EQ-5D-5L level sum score (LSS; sum of EQ-5D-5L dimensions, ranging from 5 [no problems] to 25 [extreme problems in all dimensions]), and the visual analog scale EQ VAS, 3 to 6 months after cardiac arrest. Main Outcome and Measures:Long-term survival up to a maximum of 7 years among patients surviving IHCA and OHCA. Results:In total, 2000 survivors of IHCA (median [IQR] age, 73 [65-80] years, 66% male) and 1108 survivors of OHCA (median [IQR] age, 69 [59-75] years, 77% male) were included. There were 475 deaths among patients with IHCA and 132 deaths among patients with OHCA. For patients with IHCA, the LSS distribution was 394 (20%) for LSS 5, 1034 (52%) for LSS 6 to 10, and 572 (29%) for LSS 11 to 25. For patients with OHCA, the LSS distribution was 299 (27%) for LSS 5, 637 (58%) for LSS 6 to 10, and 168 (15%) for LSS 11 to 25. In the IHCA population, LSS 11 to 25 had higher hazard of death compared with LSS 5 (adjusted hazard ratio [AHR], 2.50 [95% CI, 1.82-3.43]), whereas LSS 6 to 10 did not (AHR, 1.21 [95% CI, 0.88-1.65]). In OHCA, no associations were found between LSS categories and long-term survival (LSS 11-25 vs LSS 5: AHR, 1.41 [95% CI, 0.83-2.42]; LSS 6-10 vs LSS 5: AHR, 0.88 [95% CI, 0.56-1.39]). In both IHCA and OHCA, spline modeling using LSS and EQ VAS as continuous variables showed significant increases in hazards of death with poorer HRQOL, although the estimates in the OHCA population showed greater uncertainty. Conclusions and Relevance:In this cohort study of patients who survived beyond 90 days after IHCA or OHCA, poorer HRQOL reported with EQ-5D-5L scores 3 to 6 months after cardiac arrest was associated with reduced long-term survival in both groups, with greater uncertainty for OHCA estimates. HRQOL assessment may help guide follow-up care.

AIM:To investigate whether the aetiology of in-hospital cardiac arrest (IHCA) is associated with long-term survival after 30-day survival. METHODS:A nationwide registry-based cohort study was conducted using the Swedish Registry for Cardiopulmonary Resuscitation. Adult IHCA patients in Sweden between 2018 and 2023 who survived ≥30 days were included. Aetiologies were merged into six categories (myocardial ischemia [reference], other cardiac, pulmonary, infectious, haemorrhagic and other non-cardiac). Cox (proportional hazards) regression models were used to estimate crude and multivariable adjusted (demographics, comorbidities, arrest characteristics) hazard ratios (HRs) with 95% CIs for all-cause mortality. RESULTS:Among 2692 30-day survivors (median age 71 years; 67% male), 886 deaths (33%) occurred over a median 3.7-year follow-up; overall one‑year survival was 86%. In the fully adjusted model, higher hazards of death were observed for infectious (HR 1.79, 95% CI 1.30-2.47), haemorrhagic (1.71, 1.20-2.43), and pulmonary aetiologies (1.61, 1.24-2.11), compared to myocardial ischemia. No difference was observed for cardiac and other non‑cardiac aetiologies. CONCLUSIONS:Aetiology of in-hospital cardiac arrest is independently associated with long‑term prognosis after 30‑day survival. Compared with myocardial ischemia, infectious, haemorrhagic and pulmonary causes are associated with higher long‑term mortality. These findings support aetiology‑informed follow‑up after IHCA.

PURPOSE:To illuminate the meanings of encountering patients in a suicidal process from the perspective of ambulance clinicians. METHODS:Narrative interviews were conducted with eighteen ambulance clinicians in Sweden. Data were analyzed using a phenomenological hermeneutical approach inspired by the philosophy of Ricœur. RESULTS:The main theme, "Navigating a fragile capability," reveals a profound tension within professional identity. Traditionally anchored in technical agency, this identity is challenged by a movement toward vulnerability and shared humanity. Capability in these encounters is defined not only by medical problem-solving but by the courage to remain present during existential crises. Entering the patient's narrative imposes an extensive responsibility, where experiences of indecisiveness and powerlessness emerge as expressions of moral sensitivity rather than professional inadequacy. CONCLUSIONS:Encountering suicidal patients reveals professional capability as a fragile construct dependent on reciprocity, requiring a shift from technical agency toward an ethical presence when medical protocols reach their limit. By validating being with as a clinically meaningful component of care, the encounter moves beyond procedural care toward a meaningful ethical aim. Practically, professional standards must expand beyond technical management to integrate relational competence and existential care as core elements of prehospital practice.

Abstract Background Ambulance clinicians increasingly refer patients to self-care, positioning ambulance service within a wider gatekeeping role and necessitating the assessment of whether self-care is a safe option or if further support is needed. Contrary to primary healthcare centre (PHC) referrals, self-care referrals often lack structured follow-ups, with the decision consequences remaining underexplored. This study investigates the outcomes and predictors of subsequent healthcare contact (SHC) and mortality among patients referred to self-care by ambulance services in three Swedish regions. Methods This retrospective cohort study included 6,452 (954 children and 5,498 adults) ambulance assignments between 1 January 2023 and 31 December 31 2023 that resulted in self-care referrals. The primary outcome was SHC (PHC visits, ambulance service recontact, emergency department visits, and hospitalisations) and all-cause mortality within 72 h and 30 days. Bayesian multilevel logistic regression models were used to estimate the probability of recontact and mortality. Results Approximately 30% and 25% of the adults and children sought SHC, respectively, with the majority being PHC visits. Mortality was < 2% within 30 days, and no deaths were observed among the children. Respiratory, infectious, and medical symptoms predominated among the children, compared with medical, surgical, and neurological symptoms among adults. Predictors of SHC included increased age, longer on-scene time, advisory decision support system (ADSS) use, and distance to hospital. Conclusion Approximately one-third (30%) of patients sought SHC within 72 h of a self-care referral decision. Whilst this does not necessarily indicate adverse events, the lack follow-up and patient-reported data limits interpretation. Although the ADSS have the potential to reduce ED conveyance, they cannot replace nuanced clinical judgment, risking inequitable care for patients in rural areas, those with low health literacy, and frail older adults. Non‑conveyance decisions for patients aged 80 years or older should therefore be approached with heightened caution. Future research should explore patient perspectives to better understand re-engagement and improve the safety of self-care referrals.

Clinical ethics support (CES) is increasingly recognised as essential in healthcare, yet its evaluation remains challenging due to the complexity of CES practices and the latent, psychosocial nature of relevant outcomes. The European Moral Case Deliberation Outcomes Instruments (Euro-MCD original and 2.0) represents important steps in operationalising CES outcomes. However, there remains a need for a further theoretically grounded and psychometrically robust instrument. This study aimed to revise the Euro-MCD 2.0 and to develop and psychometrically test a new measurement instrument for CES. A sequential mixed-methods instrument redevelopment and validation design was used, guided by an abductive, theory-driven approach. Content validity processes involved conceptual framing, item revision, item development, and cognitive evaluation. Construct validity processes involved psychometric testing using survey data, incorporating principal component analysis and complementary item-level assessments. The revision of Euro-MCD 2.0 resulted in the Clinical Ethics Support Measurement Instrument (CES-MI), assessing ethical competence and ethical climate. Ethical competence comprises holding moral judgement, being responsive, and acting with moral courage (9 items, using a 5-point scale assessing perceived difficulty). Ethical climate comprises permissive dialogue, supportive relationships, and managing ethical concerns together (7 items, using a 4-point scale assessing perceived extent). Measurement properties were generally strong: targeting was appropriate, response categories functioned as intended, and only minor issues, such as limited local dependencies were observed. Reliability indices were high, unidimensionality was supported across the constructs, and no differential item functioning was detected by sex or intervention groups. The CES-MI is a coherent, theoretically grounded, and psychometrically robust instrument for measurement, suitable for both clinical practice and research. The strong validity likely reflects the extensive qualitative and psychometric work underpinning the CES-MI, together with a user-friendly response format that supports reflective and authentic self-assessment. Next steps include examining the instrument’s sensitivity to change over time for example by exploring whether open-ended follow-up questions could deepen understanding of concrete changes, as well as, assessing applicability across diverse healthcare settings.

Purpose This study aimed to describe the phenomenon of losing human life by suicide, based on the lived experiences of suicide survivors and professionals. Methods Phenomenological participatory action research was conducted, comprising 50 group sessions with 51 participants including suicide survivors, registered nurses, response police officers, and general practitioners. Results The essence of losing human life through suicide is characterized by profound emotional vulnerability when confronted with an existential tragedy. This means a powerlessness and an abrupt shift in existence, awakening the instinct to escape and the responsibility to act. Being the messenger of death is a heavy burden, and a sense of abandonment arises when survivors are left alone. Simply being together as human beings awakens a sense of vulnerability and a strong impulse to uphold human dignity. Conclusions These findings underscore that everyone involved is vulnerable to existential challenges following suicide and provide insight into the fragility of humanity. Professionals need awareness of their own vulnerability and moral courage to encounter survivors as fellow human beings. Support for survivors should acknowledge that grief and existential suffering do not follow fixed timelines. The methodological combination of phenomenology and participatory action research proved fruitful, generating rich insights and offering a promising approach for future studies.

BACKGROUND:Shared decision-making aims to ensure that healthcare professionals and patients jointly make decisions regarding the patient's care. However, professionals often find it challenging to implement shared decision-making with older patients who have cognitive impairments or diminished decision-making capacity. Research indicates a significant gap in the understanding of how decision-making processes unfold in prehospital settings. AIM:The objective of this scoping review was to explore how decision-making involving older patients in acute prehospital situations is characterized. DESIGN AND METHOD:This scoping review is based on the Joanna Briggs Institute's guidelines for scoping reviews and is reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR). DATA SOURCES:CINAHL, PubMed, Scopus, PsychINFO and Web of Science were searched to identify relevant studies published between the years 2000 and 2024. RESULTS:The results are based on 26 studies and indicate that decision-making among older patients is a conditional process, characterised by collaborative support involving the patient, significant others and healthcare professionals. Barriers to this process include hierarchical dynamics, fear of reprisals and uncertainty regarding the risk-benefit ratio. Factors that support decision-making include situationally relevant competence, organisational resources and the presence of specific symptoms and signs. CONCLUSION:Shared decision-making with older patients in acute prehospital settings is conditional, often resulting in decisions being made primarily by healthcare professionals. There is considerable room for improvement in how this process is systematically approached. A structured approach is needed-one that assesses the older patient's decision-making capacity, considers the perspectives of family members, and incorporates input from individuals who know the patient well, all while minimizing hierarchical barriers.

In Sweden, most out-of-hospital cardiac arrests (OHCAs) occur in private residences and nursing homes. Although studies suggest that nursing home staff appear hesitant to start cardiopulmonary resuscitation (CPR) before ambulance staff arrive, it is unknown whether treatment and outcomes among those who suffer OHCA in nursing homes differ from private residences. The aim of the study was to describe OHCA occurrence, treatment, and 30-day survival in people aged 65 years or older in Swedish nursing homes, in comparison with private residences. This retrospective registry study utilized data from the Swedish Register of Cardiopulmonary Resuscitation from 1992 to 2022. The study included 59 459 OHCAs. Data were analyzed using descriptive and inferential statistics, complemented with generalized linear models. The number of OHCAs was 56 379 in private residences and 3 080 in nursing homes. While the occurrence of OHCA increased in private residences it remained stable in nursing homes. The overall survival rate in people suffering OHCA in living facilities was 4.4

Background Ambulance clinicians regularly encounter medical, caring, existential and ethical challenges. Meeting patients with complex medical presentations underscore the need for holistic decision-making and actions as ambulance clinicians struggle to strike a balance between addressing medical and caring needs.Aim This study aimed to explore action alternatives considered and discussed during ethics case reflections in response to care-related challenges in ambulance services.Research design A qualitative descriptive study design was applied. Data were analyzed using conventional and summative content analysis.Participants and research context Ethics case reflections were performed with 14 groups comprising a total of 78 ambulance clinicians. Prior to the reflections, a video depicting the encounter between two ambulance clinicians and an older patient and his spouse was viewed.Ethical considerations The principles of the Declaration of Helsinki were applied throughout the research process, and an advisory statement was obtained from the Swedish Ethical Review Authority (No. 2019-02127 and 2021-03490).Findings The ethics case reflections generated a variety and breadth of action alternatives to manage challenges in caring, suggesting that this format is suitable for discussing ethical issues in clinical cases that depart from standard medical emergencies. Furthermore, the breadth of the results reveals the wide professional discretion afforded to ambulance clinicians and suggest the presence of tacit competences embedded in professional practice.Conclusions Ethics case reflection has a potential to enhance ambulance clinicians' ethical decision-making by deepening reflections about patient autonomy as well as highlighting the potential for a caring approach and promoting holistic care. By generating a breadth of specific action alternatives, many possible ways forward even in situations with complex care-related challenges are illustrated. Further investigation regarding the role of ethics case reflections to articulate implicit attitudes and tacit competencies is warranted.

Clinical Ethics Support (CES) includes various forms of systematic support to deal with ethical challenges in healthcare and case-based CES (C-CES) is used for CES in particular cases. The aim was to describe and normatively discuss organizational and methodological aspects of C-CES used in Swedish healthcare. A mixed-methods approach was used. A descriptive survey was answered regarding eight organizations on hospital, regional and national level, with large variations in the number of conducted C-CES activities. Data were compiled and frequencies calculated. Based on the survey results, normative questions were formulated. Six participants, with expertise of C-CES, participated in a normative group discussion. Field notes and transcribed data were analysed qualitatively. The top ranked goal of C-CES was "Supporting decision making". Mainly prospective cases were used and C-CES was carried out as un-planned and pre-planned sessions. The normative results showed the importance of avoiding making C-CES unattractive to clinicians, for instance by keeping the time frame. The professional backgrounds of C-CES leaders varied greatly and arguments were provided for the facilitating role and that C-CES leaders ought not facilitate where they have been clinically engaged. Identified challenges included variations in uptake of C-CES activities that do not mirror the ethical challenges of the context. The unfair uptake of C-CES can be compared with the uptake in Norway where there are legal requirements for CES. In this study patients and families were not reported to request or attend C-CES. Thus, further research and interventions are needed to ensure their representation in Swedish C-CES.

The proportion of people over the age of 65 in Sweden has steadily increased over the last 50 years. The group increasing the most is people over 90 years of age. Previous research has identified shortcomings in the management of sudden cardiac arrests (SCA) in nursing homes and in protocols for making decisions about cardiopulmonary resuscitation (CPR). Thus, there is an increased risk that people who do not wish to receive CPR or should not receive CPR on medical grounds, are subjected to unnecessary suffering. Furthermore, there is a risk that CPR is not provided as in other places in society. The aim of the study was to describe the occurrence, treatment, and outcome of SCA in nursing homes and to compare with SCA in private residences among people ≥65 in Sweden. This longitudinal descriptive study was based on data from the Swedish cardiopulmonary resuscitation registry between 1992 and 2022. People ≥65 suffering SCA in nursing homes and private residences, where CPR was initiated and an ambulance was called, were included. Descriptive statistics were used to present the results. A total of 59,459 SCAs were registered during the study period, of which 3,080 (5.18%) occurred in nursing homes and 56,379 (94.82%) in private residences. The longitudinal occurrence of SCA was comparable between the groups except for the pandemic years (Figure 1). The median (SD) age of those affected was 81.6 (±7.6) years in nursing homes and 77.9 (±7.7) years in private residences. Overall, the proportion of bystander CPR before ambulance arrival has increased over the study period and shows an average of 53.0% and is similar regardless of location (nursing homes 55.9% vs. private residences 52.8%). The total 30-day survival during the study period was 4.3%, with 3.4% vs. 4.4% in nursing homes and in private residences respectively. Survival improved longitudinally in private residences, while remaining more stable in nursing homes (Figure 2). In this study, the difference in survival between nursing homes and private residences was marginal. Therefore, treating nursing home residents with CPR should not universally be regarded as futile. During advanced care planning, careful consideration of the patient’s medical conditions for successful CPR should be explored and documented along with the patient’s preference for CPR. Fewer resuscitation attempts in nursing homes compared to private residences suggest differences in the "do not attempt cardiopulmonary resuscitation" decision-making process.Figure 1.Longitudinal occurrence Figure 2.Longitudinal 30-day survival

Decision-making regarding treatment limitations such as “Do not attempt resuscitation” (DNAR) orders for older patients has been found deficient. Patients ≥ 80 years with substantial comorbidity have little chance of surviving cardiac arrest, thus require thorough risk classification focusing on comorbidity and frailty. This study aimed to explore the degree of frailty, comorbidity and treatment limitations in patients ≥ 80 years in various forms of care. Additionally, the study examined the extent to which patients and/or relatives participated in these decisions. Descriptive, quantitative cross-sectional design. Medical records of 500 patients ≥ 80 years were reviewed: 100 medical, 100 orthopaedic and 100 surgical in-patients, in addition to 100 patients in Home Health Services (HHS) and 100 patients in Municipal Short-Term Care (MSTC). Comorbidity was classified and categorized using the Age-combined Charlson Comorbidity Index (ACCI). Frailty was assessed using the Clinical Frailty Scale (CFS). DNAR decisions as well as other treatment and care limitations were compiled. Patients’ and relatives’ participation in discussions and information about treatment limitations was also examined. Of the 500 patients, 48