1 Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts.
2 Department of Oncology, University of Calgary , Calgary, Alberta, Canada .
J Palliat Med. 2018 Jan;21(1):16-21. doi: 10.1089/jpm.2016.0473. Epub 2017 Aug 3.
To describe prevalence and content of AD documentation among NH residents by dementia stage.
The prevalence of advance directives (ADs) among nursing home (NH) residents with mild, moderate, and advanced dementia remains unclear.
Population-based, cross-sectional study of all licensed NHs in five U.S. states. Subjects included all long-stay (>90 day) NH residents with dementia, aged ≥65 years, and a Cognitive Performance Scale (CPS) score ≥1 from the 2007 to 2008 Minimum Data Set 2.0 (n = 180,621). Dementia severity was classified as follows: mild (CPS 1-2), moderate (CPS 3-4), and advanced (CPS 5-6).
ADs were defined as the presence of a living will, do-not-resuscitate order, do-not-hospitalize order, medication restriction, or feeding restriction).
Overall, 59% of residents had any AD and 17% had a living will. Prevalence of any AD increased by dementia severity: mild (51.2%), moderate (58.2%), and advanced (61.5%) (p < 0.001). In adjusted analysis, resident characteristics associated with any AD documentation included older age, female gender, being white, and having more severe dementia. Having a living will was associated with higher education (≥high school graduate vs. some high school or less) and being married.
While dementia severity was associated with greater likelihood of having documented any AD, almost 4 in 10 residents with dementia lacked any AD. Effective outreach may focus efforts on subgroups with lower odds of any AD or living wills, including non-white, less educated, and unmarried NH residents. A greater understanding of how such factors impact care planning will help to address barriers to patient-centered care for this population.
描述按痴呆症阶段划分的 NH 居民 AD 记录的流行率和内容。
在轻度、中度和重度痴呆的养老院（NH）居民中，预先指示（AD）的流行率仍不清楚。
这是一项基于人群的、对美国五个州所有有执照的 NH 的横断面研究。研究对象包括所有在 NH 中居住超过 90 天、年龄在 65 岁及以上、认知表现量表（CPS）评分≥1 且 2007 至 2008 年最低数据集 2.0 中得分≥1 的患有痴呆症的长期居民（n=180621）。痴呆症严重程度分类如下：轻度（CPS 1-2）、中度（CPS 3-4）和重度（CPS 5-6）。
AD 定义为存在生前遗嘱、不复苏命令、不住院命令、药物限制或喂养限制。
总体而言，59%的居民有任何 AD，17%的居民有生前遗嘱。任何 AD 的患病率随着痴呆症严重程度的增加而增加：轻度（51.2%）、中度（58.2%）和重度（61.5%）（p<0.001）。在调整后的分析中，与任何 AD 记录相关的居民特征包括年龄较大、女性、为白人以及患有更严重的痴呆症。有生前遗嘱与更高的教育程度（≥高中毕业生与一些高中或以下）和已婚相关。
虽然痴呆症严重程度与更有可能记录任何 AD 相关，但近 4 成的痴呆症患者没有任何 AD。有效的外展工作可能将重点放在 AD 或生前遗嘱记录可能性较低的亚组上，包括非白种人、受教育程度较低和未婚的 NH 居民。更好地了解这些因素如何影响护理计划将有助于解决该人群患者为中心护理的障碍。
