Luk James K H, Chan Felix H W
Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong, China. l:
Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong, China.
Ann Palliat Med. 2018 Jul;7(3):359-364. doi: 10.21037/apm.2017.08.13. Epub 2017 Aug 28.
Dementia will become more common as the population ages. Advanced dementia should be considered as a terminal illnesses and end-of-life (EOL) care is very much needed for this disease group. Currently, the EOL services provided to this vulnerable group in Hong Kong, especially those living in residential care homes, is limited. The usual practice of residential care homes is to send older residents with advanced dementia to acute hospitals when they are sick, irrespective of their wish, premorbid status, diagnoses and prognosis. This may not accord with what the patients perceive to be a "good death". There are many barriers for older people to die in place, both at home and at the residential care home. In the community, to enhance EOL care to residential care home for the elderly (RCHE) residents, pilot EOL program had been carried out by some Community Geriatric Assessment Teams. Since 2015, the Hospital Authority funded program "Enhance Community Geriatric Assessment Team Support to End-of-life Patients in Residential Care Homes for the Elderly" has been started. In the program, advance care planning (ACP), Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) (non-hospitalized) order will be established and the program will be expected to cover all clusters in Hong Kong by 2018/2019. In hospital setting, EOL clinical plan and EOL ward in geriatric step-down hospitals may be able to improve the quality of death of older patients. In Sep 2015, the Hospital Authority Guidelines on Life-Sustaining Treatment in the Terminally Ill was updated. Amongst other key EOL issues, careful (comfort) hand feeding was mentioned in the guideline. Other new developments include the possible establishment of enduring power of attorney for health care decision and enhancement of careful hand feeding amongst advanced dementia patients in RCHEs.
随着人口老龄化，痴呆症将变得更加普遍。晚期痴呆症应被视为一种终末期疾病，这一疾病群体非常需要临终关怀。目前，香港为这一弱势群体提供的临终关怀服务有限，尤其是那些住在安老院舍的人。安老院舍的通常做法是，将患有晚期痴呆症的老年居民在生病时送往急症医院，而不考虑他们的意愿、病前状况、诊断和预后。这可能不符合患者所认为的“善终”。老年人在原地（家中和安老院舍）离世存在许多障碍。在社区，为加强对安老院舍居民的临终关怀，一些社区老年评估小组开展了临终关怀试点项目。自2015年以来，医院管理局资助了“加强社区老年评估小组对安老院舍临终患者的支持”项目。在该项目中，将制定预先护理计划（ACP）、不进行心肺复苏（DNACPR）（非住院）指令，预计到2018/2019年该项目将覆盖香港所有地区。在医院环境中，老年康复医院的临终临床计划和临终病房可能能够提高老年患者的死亡质量。2015年9月，医院管理局更新了《末期病人维持生命治疗指引》。在其他关键的临终问题中，该指引提到了谨慎（舒适）的人工喂食。其他新进展包括可能设立医疗保健决策的持久授权书，以及加强安老院舍中晚期痴呆症患者的谨慎人工喂食。
