Finucane Anne M, Stevenson Barbara, Murray Scott A
Research Lead Marie Curie Hospice Edinburgh.
Community Palliative Care Clinical Nurse Specialist Marie Curie Hospice Edinburgh.
Int J Palliat Nurs. 2017 Sep 2;23(9):457-461. doi: 10.12968/ijpn.2017.23.9.457.
Three archetypal trajectories of physical decline have been identified: a short period of rapid decline; long-term limitations with intermittent acute periods; and a prolonged gradual decline. An understanding of illness trajectories can help clarify the evolving needs of people with progressive conditions, and inform the development of palliative care services to meet their needs. Many frail older people live and die in care homes; the present study is the first to explore the illness trajectories of residents in care home settings.
To determine the prevailing trajectories of physical decline in care home residents; and to identify the dominant illness trajectories of residents in care homes in Lothian, Scotland.
Data were collected as part of a service development project to improve palliative care in eight care homes in south Edinburgh that provided 24-hour onsite nursing care.
Data on 120 residents were collected. The dominant illness trajectory, found in 78% of residents, was prolonged gradual decline. The majority of residents (67%) had two or more long-term conditions. Overall, 74% had dementia. Only 11% of residents died in hospital; of these, most died within 1 week of admission.
Interventions to improve palliative care in care homes need to be modelled on the needs of residents who experience prolonged gradual decline characterised by frailty, dementia, multimorbidity and an uncertain prognosis.
已确定身体机能衰退的三种典型轨迹：短期内迅速衰退；长期存在局限性并伴有间歇性急性发作期；以及长期逐渐衰退。了解疾病轨迹有助于明确患有进行性疾病患者不断变化的需求，并为满足其需求的姑息治疗服务的发展提供信息。许多体弱的老年人在养老院生活和离世；本研究首次探讨了养老院居民的疾病轨迹。
确定养老院居民身体机能衰退的主要轨迹；并识别苏格兰洛锡安地区养老院居民的主要疾病轨迹。
作为一项服务发展项目的一部分收集数据，该项目旨在改善爱丁堡南部八家提供24小时现场护理的养老院的姑息治疗。
收集了120名居民的数据。在78%的居民中发现的主要疾病轨迹是长期逐渐衰退。大多数居民（67%）患有两种或更多种长期疾病。总体而言，74%的居民患有痴呆症。只有11%的居民在医院死亡；其中，大多数在入院后1周内死亡。
改善养老院姑息治疗的干预措施需要根据那些经历以体弱、痴呆、多种疾病和预后不确定为特征的长期逐渐衰退的居民的需求来制定。
