Pot Anne Margriet, Portrait France, Visser Geraldine, Puts Martine, van Groenou Marjolein I Broese, Deeg Dorly J H
EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands.
BMC Health Serv Res. 2009 Aug 5;9:139. doi: 10.1186/1472-6963-9-139.
It is well-known that the use of care services is most intensive in the last phase of life. However, so far only a few determinants of end-of-life care utilization are known. The aims of this study were to describe the utilization of acute and long-term care among older adults in their last year of life as compared to those not in their last year of life, and to examine which of a broad range of determinants can account for observed differences in care utilization.
Data were used from the Longitudinal Aging Study Amsterdam (LASA). In a random, age and sex stratified population-based cohort of 3107 persons aged 55 - 85 years at baseline and representative of the Netherlands, follow-up cycles took place at 3, 6 and 9 years. Those who died within one year directly after a cycle were defined as the "end-of-life group" (n = 262), and those who survived at least three years after a cycle were defined as the "survivors". Utilization of acute and long-term care services, including professional and informal care, were recorded at each cycle, as well as a broad range of health-related and psychosocial variables.
The end-of-life group used more care than the survivors. In the younger-old this difference was most pronounced for acute care, and in the older-old, for long-term care. Use of both acute and long-term home care in the last year of life was fully accounted for by health problems. Use of institutional care at the end of life was partly accounted for by health problems, but was not fully explained by the determinants included.
This study shows that severity of health problems are decisive in the explanation of the increase in use of care services towards the end-of-life. This information is essential for an appropriate allocation of professional health care to the benefit of older persons themselves and their informal caregivers.
众所周知，在生命的最后阶段，护理服务的使用最为密集。然而，到目前为止，仅知晓少数临终护理利用的决定因素。本研究的目的是描述老年人在生命最后一年与非生命最后一年相比急性和长期护理的利用情况，并检验一系列广泛的决定因素中哪些能够解释观察到的护理利用差异。
使用来自阿姆斯特丹纵向衰老研究（LASA）的数据。在一个基于人群的随机、按年龄和性别分层的队列中，基线时3107名年龄在55 - 85岁之间且代表荷兰的人群，随访周期为3年、6年和9年。在一个周期后一年内死亡的人被定义为“临终组”（n = 262），而在一个周期后至少存活三年的人被定义为“幸存者”。在每个周期记录急性和长期护理服务的利用情况，包括专业和非正式护理，以及一系列广泛的与健康相关和社会心理变量。
临终组比幸存者使用更多的护理。在年轻老年人中，这种差异在急性护理方面最为明显，而在年长老年人中，在长期护理方面最为明显。生命最后一年急性和长期家庭护理的使用完全由健康问题解释。临终时机构护理的使用部分由健康问题解释，但未被纳入的决定因素完全解释。
本研究表明，健康问题的严重程度对于解释临终时护理服务使用的增加具有决定性作用。这些信息对于合理分配专业医疗保健以造福老年人自身及其非正式护理人员至关重要。
