临终前住院老年患者的预先指示和护理强度。
Advance directives and intensity of care delivered to hospitalized older adults at the end-of-life.
机构信息
Marquette University, College of Nursing, PO Box 1881, Milwaukee, WI 53201, United States.
Medical College of Wisconsin, CLCC, Clinical Cancer Center, 9200 W Wisconsin Ave, Milwaukee, WI 53226, United States.
出版信息
Heart Lung. 2020 Mar-Apr;49(2):123-131. doi: 10.1016/j.hrtlng.2019.08.018. Epub 2019 Sep 3.
BACKGROUND
Older adults prefer comfort over life-sustaining care. Decreased intensity of care is associated with improved quality of life at the end-of-life (EOL).
OBJECTIVES
This study explored the association between advance directives (ADs) and intensity of care in the acute care setting at the EOL for older adults.
METHODS
A retrospective, correlational study of older adult decedents (N = 496) was conducted at an academic medical center. Regression analyses explored the association between ADs and intensity of care.
RESULTS
Advance directives were not independently predictive of aggressive care but were independently associated with referrals to palliative care and hospice; however, effect sizes were small, and the timing of referrals was late.
CONCLUSION
The ineffectiveness of ADs to reduce aggressive care or promote timely referrals to palliative and hospice services, emphasizes persistent inadequacies related to EOL care. Research is needed to understand if this failure is provider-driven or a flaw in the documents themselves.
背景
老年人更倾向于舒适而非维持生命的治疗。临终关怀治疗强度的降低与临终生活质量的提高有关。
目的
本研究旨在探讨在老年患者临终的急性护理环境中，预先指示（AD）与护理强度之间的关系。
方法
对学术医疗中心的 496 名老年死者进行了回顾性相关性研究。回归分析探讨了 AD 与护理强度之间的关系。
结果
预先指示并不能独立预测激进治疗，但与姑息治疗和临终关怀的转诊有关；然而，效应大小较小，转诊时间较晚。
结论
AD 无法减少激进治疗或促进及时转诊至姑息治疗和临终关怀服务，这突显了临终关怀护理方面持续存在的不足。需要研究以了解这种失败是由提供者驱动还是由文件本身的缺陷所致。
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