Chughtai Bilal, Thomas Dominique, Russell David, Phongtankuel Veerawat, Bowles Kathryn, Prigerson Holly
1 Department of Urology, Weill Cornell Medical College, New York- Presbyterian Hospital, New York, NY, USA.
2 Visiting Nurse Service of New York (VNSNY), New York, NY, USA.
Am J Hosp Palliat Care. 2019 Jan;36(1):33-37. doi: 10.1177/1049909118784891. Epub 2018 Jun 24.
: We sought to determine the prevalence and risk factors associated with fecal incontinence (FI) in the home hospice setting.
: We conducted a retrospective cohort study of patients served by a hospice agency. Data on patient characteristics were extracted from hospice medical records. The primary outcome, FI, was assessed routinely during clinical visits to the patient's home. Descriptive statistics were used to summarize patient characteristics. A Cox proportional hazards regression model was estimated for FI to examine associations with sociodemographic and clinical characteristics of patients.
: A total of 15 432 patients were eligible. Patients were female (59.0%) and 75 years or older (23.5% were 75-84; 39.9% were 85+). Most patients with FI indicated incontinence at the time of hospice admission (64.5%; n = 4314), with the average onset period being approximately 18 days from admission (mean = 17.9, standard deviation = 50.6). Increasing age represented a risk factor for FI (hazard ratio [HR] = 1.01 [confidence interval, CI = 1.01-1.01]). The absence of a health-care proxy was associated with an increased risk of FI (HR = 1.11 [CI = 1.04-1.19]). Greater risk of FI was observed among patients with dementia (HR = 1.34 [1.24-1.46]) and stroke (HR = 1.42 [1.26-1.60]) compared to patients with cancer. Patients referred to hospice from settings other than the hospital also had a greater risk of FI compared to those referred from the hospital (HR = 1.17 [1.11-1.23]).
: Fecal incontinence is a highly prevalent condition among home hospice patients and most patients indicated FI upon admission (median time to detection = 18 days). Further studies are needed to identify modifiable risk factors for FI detection and its symptom management in this patient population.
我们试图确定居家临终关怀环境中大便失禁（FI）的患病率及其相关危险因素。
我们对一家临终关怀机构服务的患者进行了一项回顾性队列研究。患者特征数据从临终关怀医疗记录中提取。主要结局指标FI在对患者家中进行临床访视时进行常规评估。使用描述性统计来总结患者特征。对FI估计Cox比例风险回归模型，以检验与患者社会人口统计学和临床特征的关联。
共有15432名患者符合条件。患者以女性为主（59.0%），年龄在75岁及以上（23.5%为75 - 84岁；39.9%为85岁及以上）。大多数FI患者在临终关怀入院时即有失禁情况（64.5%；n = 4314），平均发病期约为入院后18天（均值 = 17.9，标准差 = 50.6）。年龄增长是FI的一个危险因素（风险比[HR] = 1.01[置信区间，CI = 1.01 - 1.01]）。没有医疗保健代理人与FI风险增加相关（HR = 1.11[CI = 1.04 - 1.19]）。与癌症患者相比，痴呆患者（HR = 1.34[1.24 - 1.46]）和中风患者（HR = 1.42[1.26 - 1.60]）发生FI的风险更高。与从医院转诊至临终关怀机构的患者相比，从其他机构转诊的患者发生FI的风险也更高（HR = 1.17[1.11 - 1.23]）。
大便失禁在居家临终关怀患者中非常普遍，大多数患者在入院时即有FI（检测到FI的中位时间 = 18天）。需要进一步研究以确定该患者群体中可改变的FI检测危险因素及其症状管理方法。
