Hebrew SeniorLife Institute for Aging Research, Boston, Massachusetts 02131, USA.
J Am Geriatr Soc. 2010 Dec;58(12):2284-91. doi: 10.1111/j.1532-5415.2010.03185.x.
To identify characteristics of nursing home (NH) residents with advanced dementia and their healthcare proxies (HCPs) associated with hospice referral and to examine the association between hospice use and the treatment of pain and dyspnea and unmet needs during the last 7 days of life.
Prospective cohort study.
Twenty-two Boston-area NHs.
Three hundred twenty-three NH residents with advanced dementia and their HCPs.
Data were collected at baseline and quarterly for up to 18 months. Hospice referral, frequency of pain and dyspnea, and treatment of these symptoms was ascertained. HCPs reported unmet needs during the last 7 days of the residents' lives for communication, information, emotional support, and help with personal care.
Twenty-two percent of residents were referred to hospice. After multivariable adjustment, factors associated with hospice referral were nonwhite race, eating problems, HCP's perception that the resident's had less than 6 months to live, and better HCP mental health. Residents in hospice were more likely to receive scheduled opioids for pain (adjusted odds ratio (AOR)=3.16; 95% confidence interval (95% CI)=1.57-6.36) and oxygen, morphine, scopolamine, or hyoscyamine for dyspnea (AOR=3.28, 95% CI=1.37-7.86). HCPs of residents in hospice reported fewer unmet needs in all domains during the last 7 days of the residents' life.
A minority of NH residents with advanced dementia received hospice care. Hospice recipients were more likely to received scheduled opioids for pain and symptomatic treatment for dyspnea and had fewer unmet needs at the end of life.
确定患有晚期痴呆症的养老院（NH）居民及其医疗保健代理人（HCP）的特征，这些特征与临终关怀转诊有关，并研究临终关怀使用与疼痛和呼吸困难的治疗以及生命最后 7 天未满足的需求之间的关联。
前瞻性队列研究。
波士顿地区的 22 家 NH。
323 名患有晚期痴呆症的 NH 居民及其 HCP。
在基线和每季度收集数据，最多 18 个月。确定临终关怀转诊，疼痛和呼吸困难的频率以及这些症状的治疗情况。HCP 报告了居民生命的最后 7 天中在沟通，信息，情感支持和个人护理方面的未满足需求。
有 22％的居民被转介到临终关怀。经过多变量调整后，与临终关怀转诊相关的因素是非白人种族，进食问题，HCP 认为居民的生存时间不到 6 个月以及更好的 HCP 心理健康。在临终关怀中的居民更有可能接受定期的阿片类药物治疗疼痛（调整后的优势比（AOR）= 3.16；95％置信区间（95％CI）= 1.57-6.36）和氧气，吗啡，东莨菪碱或氢溴酸莨菪碱治疗呼吸困难（AOR = 3.28，95％CI = 1.37-7.86）。临终关怀中的居民的 HCP 在居民生命的最后 7 天中报告了所有领域的未满足需求都更少。
患有晚期痴呆症的 NH 居民中只有少数人接受临终关怀。临终关怀的接受者更有可能接受定期的阿片类药物治疗疼痛和症状性治疗呼吸困难，并且在生命的最后阶段未满足的需求更少。
