Sekiguchi Kenji, Bell Christina L, Masaki Kamal H, Fischberg Daniel J
1 The John A. Hartford Foundation Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii , Honolulu, Hawaii.
J Palliat Med. 2014 Dec;17(12):1353-8. doi: 10.1089/jpm.2013.0596.
Despite palliative care implementation, most deaths still occur in hospitals.
To identify factors associated with in-hospital death among elderly patients receiving palliative care, by site of consultation.
Prospective observational study.
SETTING/SUBJECTS: All inpatients aged 65 years and older receiving pain and palliative care consultations in a 533-bed acute tertiary care hospital in Honolulu, Hawaii, from January 2005 through December 2009.
During consultation, demographics, diagnoses, consultation site (intensive care unit [ICU], non-ICU medical, non-ICU surgical, and rehabilitation floors), consultation indication (assistance with establishing goals of care versus pain and/or symptom management), Karnofsky scores, length of stay (LOS), discharge disposition, and in-hospital death were collected. Multiple logistic regression analyses examined factors associated with in-hospital death.
Of 1630 elderly inpatients receiving palliative care, 305 (19%) died in-hospital. In-hospital death among non-ICU medical patients was associated with needing consultation to assist with plan of care (odds ratio [OR]=1.89, 95% confidence interval [CI]=1.27-2.80). Likelihood of in-hospital death increased 2% for each additional hospital day before consultation (OR=1.02, 95% CI=1.01-1.03). Among elderly ICU patients, likelihood of in-hospital death increased 8% for each additional hospital day before consultation (OR=1.08, 95% CI=1.01-1.16).
Among elderly non-ICU medical patients receiving palliative care consultations, the need for a consultation to assist with plan of care was associated with in-hospital death, while length of stay prior to consultation was important among both elderly ICU and non-ICU medical patients. Elderly hospitalized patients may benefit from earlier identification and palliative care consultation for assistance with plan of care to avoid in-hospital death.
尽管实施了姑息治疗，但大多数死亡仍发生在医院。
按会诊地点确定接受姑息治疗的老年患者院内死亡的相关因素。
前瞻性观察研究。
地点/研究对象：2005年1月至2009年12月期间，在夏威夷檀香山一家拥有533张床位的急性三级护理医院中，所有年龄在65岁及以上接受疼痛和姑息治疗会诊的住院患者。
会诊期间，收集人口统计学资料、诊断结果、会诊地点（重症监护病房[ICU]、非ICU内科、非ICU外科和康复病房）、会诊指征（协助确定护理目标与疼痛和/或症状管理）、卡诺夫斯基评分、住院时间（LOS）、出院处置情况和院内死亡情况。多因素逻辑回归分析检查与院内死亡相关的因素。
在1630例接受姑息治疗的老年住院患者中，305例（19%）在院内死亡。非ICU内科患者的院内死亡与需要会诊以协助护理计划有关（比值比[OR]=1.89，95%置信区间[CI]=1.27 - 2.80）。会诊前每增加一天住院时间，院内死亡的可能性增加2%（OR=1.02，95% CI=1.01 - 1.03）。在老年ICU患者中，会诊前每增加一天住院时间，院内死亡的可能性增加8%（OR=1.08，95% CI=1.01 - 1.16）。
在接受姑息治疗会诊的老年非ICU内科患者中，需要会诊以协助护理计划与院内死亡有关，而会诊前的住院时间对老年ICU和非ICU内科患者均很重要。老年住院患者可能受益于更早的识别和姑息治疗会诊，以协助制定护理计划，避免院内死亡。
