Reinhardt Joann P, Boerner Kathrin, Downes Deirdre
a Jewish Home Lifecare , New York , New York , USA.
b Department of Gerontology , John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston , Boston , Massachusetts , USA.
J Soc Work End Life Palliat Care. 2015;11(3-4):307-22. doi: 10.1080/15524256.2015.1107805.
With the progression of dementia, the need for families and health care providers to have discussions about end-of-life (EOL) treatments arises. EOL treatment decisions often involve whether or not medical interventions intended to prolong life-such as resuscitation, artificial nutrition and hydration, and use of antibiotics-are desired. It is unclear if family satisfaction with care in the nursing home may be associated with involvement in EOL treatment discussions. The frequency of discussions that family members reported having with health care team members regarding multiple life-sustaining treatments and symptom management for their relatives with advanced dementia were examined over a 6-month period along with the association of these particular discussions with care satisfaction over time. Results showed that greater frequency of discussion of EOL treatment wishes was positively associated with higher care satisfaction scores among family members of nursing home residents with dementia. When considered together, greater frequency of discussion of artificial hydration was uniquely associated with greater care satisfaction and increased care satisfaction over time. Social workers must ensure that EOL treatment discussions with older adults in the nursing home and their family members take place and that preferences are communicated among the various interdisciplinary health team members.
随着痴呆症的发展，家庭和医疗保健提供者需要讨论临终（EOL）治疗。临终治疗决策通常涉及是否需要旨在延长生命的医疗干预措施，如复苏、人工营养和补液以及使用抗生素。尚不清楚家庭对养老院护理的满意度是否与参与临终治疗讨论有关。在6个月的时间里，研究了家庭成员报告与医疗团队成员就其患有晚期痴呆症的亲属的多种维持生命治疗和症状管理进行讨论的频率，以及这些特定讨论与护理满意度随时间的关联。结果表明，在患有痴呆症的养老院居民的家庭成员中，更频繁地讨论临终治疗愿望与更高的护理满意度得分呈正相关。综合考虑，更频繁地讨论人工补液与更高的护理满意度以及随时间推移护理满意度的提高具有独特的关联。社会工作者必须确保与养老院中的老年人及其家庭成员进行临终治疗讨论，并在各跨学科医疗团队成员之间传达偏好。
