Morrison R S, Siu A L
Department of Geriatrics, Box 1070, Mount Sinai School of Medicine, One Gustave L. Levy Pl, New York, NY 10029, USA.
JAMA. 2000 Jul 5;284(1):47-52. doi: 10.1001/jama.284.1.47.
Little is known about the prognosis of acutely ill patients with end-stage dementia or about the type of care that these patients receive. If their prognosis is poor, then emphasis should be placed on palliative care for these patients rather than on curative interventions.
To examine survival for patients with end-stage dementia following hospitalization for hip fracture or pneumonia and to compare their care with that of cognitively intact older adults.
Prospective cohort study with 6 months of follow-up.
Patients aged 70 years or older who were hospitalized with hip fracture (cognitively intact, n=59; with end-stage dementia, n=38) or pneumonia (cognitively intact, n=39; with end-stage dementia, n=80) in a large hospital in New York, NY, between September 1, 1996, and March 1, 1998.
Mortality, treatments directed at symptoms, and application of distressing and painful procedures in cognitively intact patients vs those with end-stage dementia.
Six-month mortality for patients with end-stage dementia and pneumonia was 53% (95% confidence interval [CI], 41%-64%) compared with 13% (95% CI, 4%-27%) for cognitively intact patients (adjusted hazard ratio, 4.6; 95% CI, 1.8-11.8). Six-month mortality for patients with end-stage dementia and hip fracture was 55% (95% CI, 42%-75%) compared with 12% (95% CI, 5%-24%) for cognitively intact patients (adjusted hazard ratio, 5.8; 95% CI, 1.7-20.4). Patients with end-stage dementia received as many burdensome procedures as cognitively intact patients and only 8 (7%) of 118 patients with end-stage dementia had a documented decision made to forego a life-sustaining treatment other than cardiopulmonary resuscitation. Only 24% of patients with end-stage dementia and hip fracture received a standing order for analgesics.
In this study, patients with advanced dementia and hip fracture or pneumonia had a very poor prognosis. Given the limited life expectancy of patients with end-stage dementia following these illnesses and the burdens associated with their treatment, increased attention should be focused on efforts to enhance comfort in this patient population. JAMA. 2000;284:47-52
对于患有终末期痴呆的急性病患者的预后情况以及这些患者所接受的护理类型，人们了解甚少。如果他们的预后很差，那么就应该将重点放在为这些患者提供姑息治疗上，而不是治愈性干预措施。
研究髋部骨折或肺炎住院后的终末期痴呆患者的生存情况，并将他们所接受的护理与认知功能正常的老年人进行比较。
前瞻性队列研究，随访6个月。
1996年9月1日至1998年3月1日期间，纽约一家大型医院中因髋部骨折（认知功能正常者59例，终末期痴呆者38例）或肺炎（认知功能正常者39例，终末期痴呆者80例）住院的70岁及以上患者。
认知功能正常患者与终末期痴呆患者的死亡率、针对症状的治疗以及令人痛苦和疼痛的操作的应用情况。
终末期痴呆合并肺炎患者的6个月死亡率为53%（95%置信区间[CI]，41%-64%），而认知功能正常患者为13%（95%CI，4%-27%）（调整后风险比，4.6；95%CI，1.8-11.8）。终末期痴呆合并髋部骨折患者的6个月死亡率为55%（95%CI，42%-75%），而认知功能正常患者为12%（95%CI，5%-24%）（调整后风险比，5.8；95%CI，1.7-20.4）。终末期痴呆患者接受的繁重操作与认知功能正常患者一样多，在118例终末期痴呆患者中，只有8例（7%）有记录表明做出了放弃除心肺复苏之外的维持生命治疗的决定。终末期痴呆合并髋部骨折的患者中只有24%收到了镇痛药的长期医嘱。
在本研究中，患有晚期痴呆且髋部骨折或肺炎的患者预后非常差。鉴于这些疾病后终末期痴呆患者的预期寿命有限以及与其治疗相关的负担，应更加关注努力提高这一患者群体的舒适度。《美国医学会杂志》。2000年；284：47-52
