Department of Forensic Medicine, Monash University, Victoria, Australia; Ballarat Health Services, Ballarat 3350, Australia.
Ballarat Health Services, Ballarat 3350, Australia.
Resuscitation. 2016 Jan;98:118-24. doi: 10.1016/j.resuscitation.2015.03.014. Epub 2015 Mar 26.
The prevalence of dementia is growing with an ageing population. Most persons with dementia die of acute illness and many are hospitalised at the end of life. In the acute hospital setting, limitation of care orders (LCOs) such as Do Not Attempt CPR and Physician Orders For Life Sustaining Treatment (POLST), appear to be underused in patients with dementia. These patients receive the same aggressive life-prolonging therapies as any other patient, despite drastically higher mortality. However, limitation of care orders in patients with dementia is not addressed by current guidelines or policies. Systems and processes for obtaining and documenting LCO need improvement at the individual, organisational and societal level. The issue is controversial amongst the public and poorly understood by clinicians. Balanced and empathetic decision-making requires an individualised approach and recognition of the complexities (legal, ethical and clinical) of this issue. We examine the domains of: (a) treatment effectiveness, (b) burden of care and quality of life and (c) patient autonomy and capacity.
人口老龄化导致痴呆症的患病率不断上升。大多数痴呆症患者死于急性疾病，许多人在生命的最后阶段住院。在急性医院环境中，限制护理令（LCO），如不进行心肺复苏术和医生维持生命治疗令（POLST），在痴呆症患者中似乎未被充分使用。尽管这些患者的死亡率要高得多，但他们接受的积极延长生命的治疗方法与任何其他患者相同。然而，目前的指南或政策并未涉及痴呆症患者的限制护理令。在个人、组织和社会层面上，获取和记录 LCO 的系统和流程需要改进。这个问题在公众中存在争议，临床医生也对此理解不足。平衡和富有同理心的决策需要个性化的方法，并认识到这个问题的复杂性（法律、伦理和临床）。我们检查了以下三个方面：（a）治疗效果，（b）护理负担和生活质量，以及（c）患者自主权和能力。
