Wray N, Brody B, Bayer T, Boisaubin E, Davila F, Dresser R, Dunn J K, Engelhardt H T, Haley H, Hamilton J D
Department of Medicine, Baylor College of Medicine, Houston.
Arch Intern Med. 1988 Sep;148(9):1980-4.
We performed an observational study to determine the prevalence of severe dementia in a general medicine unit, the categories of acute medical care provided to these patients, the process by which treatment decisions are made, and their cost implications. The prevalence of severe dementia was 4.4%. The patients from whom some form of acute medical care was withheld (26 [45.6%] of 57) were more severely ill at admission and had a mortality rate five times higher than those who received full care. Physicians cited family wishes in 75.9% of the decisions to limit care but in only 10.9% of the decisions to give full care. The only differences in charges incurred were due to differential mortality rates in individuals from whom care was withheld. We recommend that hospitals develop and implement protocols for decision making in the care of the severely demented to promote open discussions among providers and families and to increase family contributions to decision making. We believe that the extension of this consultative approach to decisions involving severely demented patients may have the virtue of combining more humane care with more cost-effective care.
我们开展了一项观察性研究，以确定综合内科中重度痴呆的患病率、为这些患者提供的急性医疗护理类别、治疗决策的制定过程及其成本影响。重度痴呆的患病率为4.4%。被 withhold 某种形式急性医疗护理的患者（57例中的26例[45.6%]）入院时病情更严重，死亡率比接受全面护理的患者高五倍。在75.9%的限制护理决策中，医生提到了家属的意愿，但在仅10.9%的给予全面护理的决策中才提到。产生的费用方面的唯一差异是由于被 withhold 护理的个体死亡率不同。我们建议医院制定并实施针对重度痴呆患者护理决策的方案，以促进医护人员与家属之间的公开讨论，并增加家属在决策中的参与度。我们认为，将这种咨询方法扩展到涉及重度痴呆患者的决策中，可能具有将更人道的护理与更具成本效益的护理相结合的优点。
