Lino Maestroni Foundation, Palliative Medicine Research Institute, via Palestro 1, 26100, Cremona, Italy.
Department of Health and Social Services Polo Lombardia 2, Don Carlo Gnocchi Foundation ONLUS, Via Palazzolo, 21, 20149, Milan, Italy.
BMC Palliat Care. 2019 Dec 27;18(1):117. doi: 10.1186/s12904-019-0510-x.
Barriers to palliative care still exist in long-term care settings for older people, which can mean that people with advanced dementia may not receive of adequate palliative care in the last days of their life; instead, they may be exposed to aggressive and/or inappropriate treatments. The aim of this multicentre study was to assess the clinical interventions and care at end of life in a cohort of nursing home (NH) residents with advanced dementia in a large Italian region.
This retrospective study included a convenience sample of 29 NHs in the Lombardy Region. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the 7 days before death.
Most residents (97.1%) died in the NH. In the 7 days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs were prescribed. Fifty-seven percent of residents had an acknowledgement of worsening condition recorded in their clinical records, a median of 4 days before death.
Full implementation of palliative care was not achieved in our study, possibly due to insufficient acknowledgement of the appropriateness of some drugs and interventions, and health professionals' lack of implementation of palliative interventions. Future studies should focus on how to improve care for NH residents.
老年人长期护理机构中仍然存在姑息治疗的障碍，这可能意味着患有晚期痴呆症的人在生命的最后几天可能无法得到足够的姑息治疗；相反，他们可能会接受激进和/或不适当的治疗。这项多中心研究的目的是评估在意大利一个大区的护理院（NH）中患有晚期痴呆症的患者队列的临终临床干预和护理。
这项回顾性研究包括伦巴第大区的 29 个 NH。数据来自 482 名患有晚期痴呆症的居民的临床记录，这些居民在 NH 居住至少 6 个月后死亡，主要集中在死亡前的 7 天。
大多数居民（97.1%）在 NH 中死亡。在死亡前的 7 天，20%的居民经口喂食和补水，13.4%的居民通过胃管喂食。中位数有五种药物，往往是不适当的，被开了处方。57%的居民的临床记录中有病情恶化的记录，中位数为死亡前 4 天。
在我们的研究中，姑息治疗的全面实施并未实现，这可能是由于对某些药物和干预措施的适当性的认识不足，以及卫生专业人员对姑息治疗干预措施的执行不足。未来的研究应侧重于如何改善 NH 居民的护理。
