Chen Jen-Hau, Chan Ding-Cheng Derrick, Kiely Dan K, Morris John N, Mitchell Susan L
Hebrew SeniorLife, Institute for Aging Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
J Gerontol A Biol Sci Med Sci. 2007 May;62(5):531-6. doi: 10.1093/gerona/62.5.531.
Little is known about the terminal trajectories of functional decline among long-term care (LTC) residents dying with different diseases.
A retrospective cohort study was performed on 747 individuals aged 65 or older who died between January 1994 and December 2004 in a 675-bed LTC facility in Massachusetts. Three study groups were created: advanced dementia, n = 314 (42%); terminal cancer, n = 63 (8%); and organ failure (congestive heart failure and chronic obstructive pulmonary disease), n = 370 (50%). Quarterly scores of 7 activities of daily living (ADLs) during the last year of life derived from the Minimum Data Set were compared among the three groups. Each activity was rated from 0 to 4 (higher scores indicate more dependence; total range, 0-28).
The mean age of all individuals at death was 91 +/- 6 (standard deviation) years. Functional decline was greatest during the last 3 months of life, but this decline was most precipitous in the terminal cancer and organ failure groups compared to the advanced dementia group. The mean change in ADL scores during the last year of life differed among the three groups (p <.001), with the greatest decline in the terminal cancer group (from initial score 13 to final score 25), followed by the organ failure group (13 to 22), and finally, the advanced dementia group (24 to 27).
The terminal trajectories of functional decline among LTC residents vary by underlying diseases. An understanding of these trajectories may be useful to clinicians and families caring for LTC residents near the end of life.
对于在长期护理机构中因不同疾病离世的居民，其功能衰退的终末轨迹了解甚少。
对1994年1月至2004年12月期间在马萨诸塞州一家拥有675张床位的长期护理机构中死亡的747名65岁及以上老人进行了一项回顾性队列研究。创建了三个研究组：晚期痴呆，n = 314（42%）；晚期癌症，n = 63（8%）；以及器官衰竭（充血性心力衰竭和慢性阻塞性肺疾病），n = 370（50%）。比较了三组在生命最后一年中来自最小数据集的7项日常生活活动（ADL）的季度评分。每项活动的评分为0至4分（分数越高表示依赖程度越高；总分范围为0 - 28分）。
所有个体死亡时的平均年龄为91±6（标准差）岁。功能衰退在生命的最后3个月最为严重，但与晚期痴呆组相比，晚期癌症组和器官衰竭组的衰退最为急剧。三组在生命最后一年中ADL评分的平均变化有所不同（p <.001），晚期癌症组下降幅度最大（从初始评分13分降至最终评分25分），其次是器官衰竭组（13分至22分），最后是晚期痴呆组（24分至27分）。
长期护理机构居民功能衰退的终末轨迹因潜在疾病而异。了解这些轨迹可能对照顾临终长期护理机构居民的临床医生和家属有用。
