Kinley Julie, Hockley Jo
Care Homes, St Christopher's Hospice, London.
Int J Palliat Nurs. 2010 May;16(5):216-23. doi: 10.12968/ijpn.2010.16.5.48142.
Increasing numbers of older people are dying in the nursing care home setting. Little is known about the medication needs of the very old and frail in the last weeks of life and how they might differ from a model of care developed for people dying from cancer.
A baseline review of medication in the last month of life was undertaken to try and establish current practice of prescribing for this population. The notes of 48 deceased residents in seven nursing care homes were examined, alongside a questionnaire sent to 67 trained nurses.
Subcutaneous prescribing only occurred where specialist palliative care teams had been involved with the residents' care. Syringe drivers were used in 23% of cases; however, only three residents required a syringe driver for more than a day and a half. Nurses' confidence and competence in setting up syringe drivers was varied.
The use of syringe drivers may not be the most appropriate way of managing symptoms during the dying phase in very frail and old people.
在养老院环境中死亡的老年人数量日益增加。对于高龄体弱老人在生命最后几周的用药需求，以及这些需求与为癌症临终患者制定的护理模式有何不同，我们知之甚少。
对生命最后一个月的用药情况进行基线审查，以尝试确立针对该人群的当前处方实践。检查了七家养老院中48名已故居民的病历，并向67名经过培训的护士发放了问卷。
仅在专科姑息治疗团队参与居民护理的情况下才会进行皮下给药。23%的病例使用了注射泵；然而，只有三名居民使用注射泵的时间超过一天半。护士在设置注射泵方面的信心和能力各不相同。
对于非常体弱的老年人，在临终阶段使用注射泵可能不是管理症状的最合适方式。
