Department of General Practice and Elderly Care Medicine and EMGO+ Institute for Health and Care Research, VUmc Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.
End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Brussels, Belgium.
Int J Geriatr Psychiatry. 2017 Dec;32(12):e43-e49. doi: 10.1002/gps.4650. Epub 2016 Dec 29.
The objective was to describe end-of-life treatment decisions for patients dying with dementia in various stages of dementia in long-term care facilities in the Netherlands with elderly care physicians responsible for treatment and care.
We present data collected in the nationally representative Dutch End of Life in Dementia study (2007-2011). Within 2 weeks after death, 103 physicians completed questionnaires about the last phase of life in 330 residents with dementia who resided in 1 of 34 participating long-term care facilities. We used descriptive statistics.
Advance directives were rare (4.9%). A minority was hospitalized (8.0%) in the last month (mainly for fractures) or received antibiotics (24.2%) in the last week (mainly for pneumonia). Four residents received tube feeding or rehydration therapy in the last week. In almost half of the residents (42.3%), decisions were made not to start potentially life-prolonging treatment such as hospital transfer and artificial nutrition and hydration. In more than half of the residents (53.7%), decisions were made to withdraw potentially life-prolonging treatment such as artificial nutrition and hydration and medication. Antibiotics were more frequently prescribed for residents with less advanced dementia, but otherwise there were no differences in treatment decisions between residents with advanced and less advanced dementia.
Physicians often withhold potentially burdensome life-prolonging treatment in nursing home residents in all stages of dementia in the Netherlands. This suggests that the physicians feel that a palliative care approach is appropriate at the end of life in dementia in long-term care. Copyright © 2016 John Wiley & Sons, Ltd. StartCopTextCopyright © 2016 John Wiley & Sons, Ltd.
本研究旨在描述荷兰长期护理机构中患有痴呆症的患者在不同痴呆阶段的临终治疗决策，这些患者由负责治疗和护理的老年科医生进行治疗。
我们呈现了在全国代表性的荷兰痴呆症末期研究（2007-2011 年）中收集的数据。在死亡后 2 周内，103 名医生完成了关于居住在 34 个参与长期护理机构中的 330 名痴呆症患者生命最后阶段的调查问卷。我们使用了描述性统计方法。
预先指示很少见（4.9%）。少数患者在最后一个月住院（主要是因为骨折）或在最后一周接受抗生素治疗（24.2%），主要是为了治疗肺炎。有 4 名患者在最后一周接受了管饲或补液治疗。将近一半的患者（42.3%）做出了不开始可能延长生命的治疗决策，如医院转院和人工营养和水合作用。在超过一半的患者（53.7%）中，做出了停止可能延长生命的治疗决策，如人工营养和水合作用以及药物治疗。对于痴呆程度较轻的患者，抗生素的使用更为频繁，但在痴呆程度较重和较轻的患者之间，治疗决策没有差异。
荷兰的长期护理机构中，医生经常为所有痴呆阶段的患者拒绝可能带来负担的延长生命的治疗。这表明，医生认为在长期护理中，临终关怀方法是适当的。
