Program Development Center, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands; Center of Expertise for Palliative Care, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.
Department of General Practice and Department of Health Services Research, Old Age Medicine, Faculty of Health Medicine and Life Science CAPHRI, Maastricht University, Maastricht, The Netherlands.
J Am Med Dir Assoc. 2014 Feb;15(2):127-32. doi: 10.1016/j.jamda.2013.10.002. Epub 2013 Dec 4.
Care dependency is a determinant of quality of life and survival among patients with advanced chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), or chronic renal failure (CRF). The objectives of this study were to explore the profiles of care dependency in patients with advanced COPD, CHF, or CRF; to study the changes in care dependency during 1-year follow-up; and to study whether 1-year changes in care dependency are comparable between patients with advanced COPD, CHF, or CRF.
Longitudinal observational study.
Clinically stable patients with advanced COPD (n = 105), CHF (n = 80), or CRF (n = 80) were recruited at outpatient clinics of 7 Dutch hospitals.
Patients were visited at home at baseline, and at 4, 8, and 12 months to assess demographic and clinical characteristics, comorbidities (Charlson comorbidity index), care dependency (Care Dependency Scale), mobility, health status, and symptom burden.
COPD and CHF patients reported a higher baseline level of care dependency than patients with CRF. Care dependency differed between patients with COPD, CHF, or CRF in the items 'getting (un)dressed,' 'hygiene,' 'contact with others,' and 'sense of rules/values.' One-year follow-up was completed by 206 patients (77.7%). Patients with COPD were more likely to experience an increase in care dependency. An increase in care dependency was associated with higher age, higher number of hospital admissions, decrease in health status, and worsening of Charlson comorbidity index score.
Care dependency profiles differ between patients with COPD, CHF, or CRF. Patients with advanced COPD are at risk for a 1-year increase in care dependency. Regular assessment of care dependency and addressing care dependency in palliative care programs for patients with advanced COPD, CHF, or CRF are needed.
在患有晚期慢性阻塞性肺疾病（COPD）、慢性心力衰竭（CHF）或慢性肾衰竭（CRF）的患者中，依赖护理是生活质量和生存的决定因素。本研究的目的是探索晚期 COPD、CHF 或 CRF 患者的护理依赖特征；研究 1 年随访期间护理依赖的变化；并研究晚期 COPD、CHF 或 CRF 患者 1 年护理依赖变化是否具有可比性。
纵向观察性研究。
在荷兰 7 家医院的门诊招募了 105 例临床稳定的晚期 COPD 患者、80 例 CHF 患者和 80 例 CRF 患者。
在基线时、第 4、8 和 12 个月，患者在家中接受访视，以评估人口统计学和临床特征、合并症（Charlson 合并症指数）、护理依赖（护理依赖量表）、活动能力、健康状况和症状负担。
COPD 和 CHF 患者的护理依赖基线水平高于 CRF 患者。COPD、CHF 或 CRF 患者在“穿衣/脱衣”、“卫生”、“与他人接触”和“遵守规则/价值观”等项目上的护理依赖存在差异。206 例患者（77.7%）完成了 1 年随访。COPD 患者更有可能出现护理依赖增加。护理依赖增加与年龄较大、住院次数增加、健康状况下降以及 Charlson 合并症指数评分恶化有关。
COPD、CHF 或 CRF 患者的护理依赖特征不同。晚期 COPD 患者有 1 年内护理依赖增加的风险。需要定期评估护理依赖，并在晚期 COPD、CHF 或 CRF 患者的姑息治疗计划中解决护理依赖问题。
