在生命的最后一个月中，患有痴呆症的老年人的疼痛和急诊科使用情况。
Pain and Emergency Department Use in the Last Month of Life Among Older Adults With Dementia.
机构信息
Department of Physiological Nursing, University of California, San Francisco, USA; San Francisco VA Health Care System, USA.
Division of Geriatrics, University of California, San Francisco, USA.
出版信息
J Pain Symptom Manage. 2018 Dec;56(6):871-877.e7. doi: 10.1016/j.jpainsymman.2018.09.005. Epub 2018 Sep 15.
CONTEXT
Pain may be a potentially modifiable risk factor for expensive and burdensome emergency department (ED) visits near the end of life for older adults with dementia.
OBJECTIVES
The objective of this study was to assess the effect of pain and unmet need for pain management on ED visits in the last month of life in older adults with dementia.
METHODS
This is a mortality follow-back study of older adults with dementia in the National Health and Aging Trends Study who died between 2012 and 2014, linked to Medicare claims.
RESULTS
Two hundred eighty-one National Health and Aging Trends Study decedents with dementia met criteria (mean age 86 years, 61% female, 81% white). Fifty-seven percent had at least one ED visit in the last month of life, and 46.5% had an ED visit that resulted in a hospital admission. Almost three out of four (73%) of decedents experienced pain in the last month of life, and 10% had an unmet need for pain management. After adjustment for age, gender, race, educational attainment, income, comorbidities, and impairment in activities of daily living, pain was not associated with increased ED use in the last month of life (adjusted incident rate ratio 0.87, 95% CI 0.64-1.17). However, decedents with unmet need for pain management had an almost 50% higher rate of ED visits in the last month of life than those without unmet needs (adjusted incident rate ratio 1.46, 95% CI 1.07-1.99).
CONCLUSION
Among older adults with dementia, unmet need for pain management was associated with more frequent ED visits in the last month of life.
背景
疼痛可能是导致老年痴呆症患者生命末期昂贵且负担沉重的急诊就诊的潜在可改变的危险因素。
目的
本研究旨在评估疼痛和疼痛管理需求未得到满足对老年痴呆症患者生命末期急诊就诊的影响。
方法
这是一项对国家健康老龄化趋势研究中 2012 年至 2014 年间死亡的老年痴呆症患者进行的死亡后随访研究，与医疗保险索赔相关联。
结果
281 名符合条件的国家健康老龄化趋势研究死亡的老年痴呆症患者（平均年龄 86 岁，61%为女性，81%为白人）。57%的患者在生命的最后一个月至少有一次急诊就诊，46.5%的患者因急诊就诊而住院。近四分之三（73%）的死者在生命的最后一个月经历了疼痛，10%的患者有疼痛管理需求未得到满足。在调整年龄、性别、种族、教育程度、收入、合并症和日常生活活动能力受损后，疼痛与生命最后一个月急诊就诊的增加无关（调整后的发病率比为 0.87，95%CI 0.64-1.17）。然而，与没有未满足需求的患者相比，有疼痛管理需求未得到满足的患者在生命最后一个月急诊就诊的比例几乎高出 50%（调整后的发病率比为 1.46，95%CI 1.07-1.99）。
结论
在老年痴呆症患者中，疼痛管理需求未得到满足与生命末期急诊就诊的频率增加有关。
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