Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island, USA.
J Am Geriatr Soc. 2012 Nov;60(11):2035-41. doi: 10.1111/j.1532-5415.2012.04204.x. Epub 2012 Oct 30.
To examine differences in outcomes according to hospice status of skilled nursing facility (SNF) care recipients.
Retrospective cohort.
Three thousand three hundred fifty-three U.S. nursing homes (NHs).
Four thousand three hundred forty-four persons with advanced dementia who died in NHs in 2006 and received SNF care within 90 days of death were studied, 1,086 of these also received hospice before death: 705 after SNF care, and 381 concurrent with SNF care.
Treatments, persistent pain and dyspnea, and hospital death.
Decedents with any hospice received fewer medications, injections, feeding tubes, intravenous fluids, and therapy services and more hypnotics than those without hospice (all P < .001). Decedents with hospice after SNF care received fewer antipsychotics and those with hospice concurrent with SNF care received more antipsychotics than those without (all P < .001). Multivariate logistic regressions showed that decedents with hospice after SNF had lower likelihood of persistent dyspnea (adjusted odds ratio (AOR) = 0.63, 95% confidence interval (CI) = 0.45-0.87) and hospital death (AOR = 0.02, 95% = CI 0.01, 0.07) than those without hospice. Decedents with hospice concurrent with SNF care had a higher likelihood of persistent pain (AOR = 1.65, 95% CI = 1.23, 2.19) and a lower likelihood of hospital death (AOR = 0.13, 95% CI = 0.07, 0.26) than those without hospice.
Residents dying with advanced dementia who received SNF care in the last 90 days of life had fewer aggressive treatments and lower odds of hospital death if they also received hospice care at any point during that time. Associations between hospice and persistent pain or dyspnea differed according to whether hospice care was received concurrent with or after SNF care.
考察临终关怀状况不同的熟练护理机构（SNF）护理接受者结局的差异。
回顾性队列研究。
美国 3353 家养老院（NHs）。
2006 年在 NHs 去世并在去世前 90 天内接受 SNF 护理的 4344 名患有晚期痴呆症的人，其中 1086 人在去世前接受了临终关怀：705 人在 SNF 护理后接受，381 人同时接受 SNF 护理。
治疗、持续性疼痛和呼吸困难以及医院死亡。
接受任何临终关怀的死者接受的药物、注射、喂养管、静脉输液和治疗服务较少，而镇静剂较多（均 P <.001）。在 SNF 护理后接受临终关怀的死者接受的抗精神病药较少，而同时接受 SNF 护理和临终关怀的死者接受的抗精神病药较多（均 P <.001）。多变量逻辑回归显示，在 SNF 后接受临终关怀的死者持续性呼吸困难（调整后的优势比（AOR）=0.63，95%置信区间（CI）=0.45-0.87）和医院死亡（AOR=0.02，95%CI=0.01，0.07）的可能性低于未接受临终关怀的患者。同时接受 SNF 护理和临终关怀的死者持续性疼痛的可能性较高（AOR=1.65，95%CI=1.23，2.19），而医院死亡的可能性较低（AOR=0.13，95%CI=0.07，0.26），而未接受临终关怀的患者。
在生命的最后 90 天内接受 SNF 护理的患有晚期痴呆症的居民，如果在此期间任何时候都接受临终关怀护理，接受的侵袭性治疗较少，且医院死亡的可能性较低。临终关怀与持续性疼痛或呼吸困难之间的关联因临终关怀是在 SNF 护理后还是同时接受而有所不同。
