Alcorn Gemma, Murray Scott A, Hockley Jo
Primary Palliative Care Research Group, Usher Institute of Population Health Sciences, University of Edinburgh, Edinburgh.
Age Ageing. 2020 Apr 27;49(3):468-480. doi: 10.1093/ageing/afz174.
Care home residents are increasingly frail with complex health and social care needs. Their transfer to hospital at the end-of-life can be associated with unwanted interventions and distress. However, hospitals do enable provision of care that some residents wish to receive. We aimed to explore the factors that influence hospital admission of care home residents who then died in hospital.
This study combined in-depth case note review of care home residents dying in two Scottish teaching hospitals during a 6-month period and semi-structured interviews with a purposive sample of 26 care home staff and two relatives.
During the 6-month period, 109 care home residents died in hospital. Most admissions occurred out-of-hours (69%) and most were due to a sudden event or acute change in clinical condition (72%). Length of stay in hospital before death was short, with 42% of deaths occurring within 3 days. Anticipatory Care Planning (ACP) regarding hospital admission was documented in 44%.Care home staff wanted to care for residents who were dying; however, uncertain trajectories of decline, acute events, challenges of ACP, relationship with family and lack of external support impeded this.
Managing acute changes on the background of uncertain trajectories is challenging in care homes. Enhanced support is required to improve and embed ACP in care homes and to provide rapid, 24 hours-a-day support to manage difficult symptoms and acute changes.
养老院居民日益体弱，有着复杂的健康和社会护理需求。他们在临终时转院可能会伴随着不必要的干预和痛苦。然而，医院确实能够提供一些居民希望接受的护理。我们旨在探讨影响入住医院后在医院死亡的养老院居民的因素。
本研究结合了对在6个月期间于两家苏格兰教学医院死亡的养老院居民的深入病例记录审查，以及对26名养老院工作人员和两名亲属的目的抽样进行的半结构化访谈。
在这6个月期间，109名养老院居民在医院死亡。大多数入院发生在非工作时间（69%），大多数是由于突发事件或临床状况的急性变化（72%）。死亡前在医院的住院时间很短，42%的死亡发生在3天内。关于入院的预立护理计划（ACP）记录在案的占44%。养老院工作人员希望照顾临终的居民；然而，病情恶化轨迹不确定、急性事件、ACP的挑战、与家人的关系以及缺乏外部支持阻碍了这一点。
在养老院中，在病情轨迹不确定的背景下管理急性变化具有挑战性。需要加强支持，以改善并将ACP纳入养老院，并提供全天候的快速支持，以管理棘手的症状和急性变化。
