Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.
Palliat Med. 2019 Dec;33(10):1282-1298. doi: 10.1177/0269216319866648. Epub 2019 Aug 1.
End-of-life hospitalizations in nursing home residents are common, although they are often burdensome and potentially avoidable.
We aimed to summarize the existing evidence on end-of-life hospitalizations in nursing home residents.
Systematic review (PROSPERO registration number CRD42017072276).
A systematic literature search was carried out in PubMed, CINAHL, and Scopus (date of search 9 April 2019). Studies were included if they reported proportions of in-hospital deaths or hospitalizations of nursing home residents in the last month of life. Two authors independently selected studies, extracted data, and assessed the quality of studies. Median with interquartile range was used to summarize proportions.
A total of 35 studies were identified, more than half of which were from the United States ( = 18). While 29 studies reported in-hospital deaths, 12 studies examined hospitalizations during the last month of life. The proportion of in-hospital deaths varied markedly between 5.9% and 77.1%, with an overall median of 22.6% (interquartile range: 16.3%-29.5%). The proportion of residents being hospitalized during the last month of life ranged from 25.5% to 69.7%, and the median was 33.2% (interquartile range: 30.8%-38.4%). Most studies investigating the influence of age found that younger age was associated with a higher likelihood of end-of-life hospitalization. Four studies assessed trends over time, showing heterogeneous findings.
There is a wide variation in end-of-life hospitalizations, even between studies from the same country. Overall, such hospitalizations are common among nursing home residents, which indicates that interventions tailored to each specific health care system are needed to improve end-of-life care.
在养老院居住的患者临终前常常住院，尽管这些住院往往是负担沉重且潜在可避免的。
我们旨在总结养老院居住的患者临终前住院的现有证据。
系统评价（PROSPERO 注册号 CRD42017072276）。
在 PubMed、CINAHL 和 Scopus 中进行了系统文献检索（检索日期为 2019 年 4 月 9 日）。如果研究报告了养老院居住的患者临终前 1 个月内的住院或院内死亡比例，则纳入研究。两名作者独立选择研究、提取数据并评估研究质量。使用中位数和四分位距总结比例。
共确定了 35 项研究，其中超过一半来自美国（ = 18）。虽然 29 项研究报告了院内死亡，但有 12 项研究检查了临终前 1 个月的住院情况。院内死亡比例在 5.9%至 77.1%之间差异显著，总体中位数为 22.6%（四分位距：16.3%-29.5%）。临终前 1 个月住院的居民比例为 25.5%至 69.7%，中位数为 33.2%（四分位距：30.8%-38.4%）。大多数研究调查年龄的影响发现，年龄越小，临终前住院的可能性越高。有 4 项研究评估了随时间的趋势，结果存在异质性。
即使是来自同一国家的研究，临终前住院的情况也存在很大差异。总体而言，养老院居住的患者此类住院较为常见，这表明需要针对每个特定的医疗保健系统进行量身定制的干预措施，以改善临终关怀。
