School of Population and Global Health, The University of Western Australia, Crawley, Australia.
Monash Nursing and Midwifery, Monash University, Clayton, Australia.
J Am Geriatr Soc. 2020 Aug;68(8):1825-1833. doi: 10.1111/jgs.16458. Epub 2020 Apr 24.
Our aim was to (1) describe the clinical characteristics and symptoms of people diagnosed with dementia at the time of admission to inpatient palliative care; and (2) compare the nature and severity of these palliative care-related problems to patients with other chronic diseases.
Descriptive study using assessment data on point of care outcomes (January 1, 2013, to December 31, 2018).
A total of 129 inpatient palliative care services participating in the Australian Palliative Care Outcomes Collaboration.
A total of 29,971 patients with a primary diagnosis of dementia (n = 1,872), lung cancer (n = 19,499), cardiovascular disease (CVD, n = 5,079), stroke (n = 2,659), or motor neuron disease (MND, n = 862).
This study reported the data collected at the time of admission to inpatient palliative care services including patients' self-rated levels of distress from seven common physical symptoms, clinician-rated symptom severity, functional dependency, and performance status. Other data analyzed included number of admissions, length of inpatient stay, and palliative care phases.
At the time of admission to inpatient palliative care services, relative to patients with lung cancer, CVD, and MND, people with dementia presented with lower levels of distress from most symptoms (odds ratios [ORs] range from .15 to .80; P < .05 for all) but higher levels of functional impairment (ORs range from 3.02 to 8.62; P < .001 for all), and they needed more assistance with basic activities of daily living (ORs range from 3.83 to 12.24; P < .001 for all). The trends were mostly the opposite direction when compared with stroke patients. Patients with dementia tended to receive inpatient palliative care later than those with lung cancer and MND.
The unique pattern of palliative care problems experienced by people with dementia, as well as the skills of the relevant health services, need to be considered when deciding on the best location of care for each individual. Access to appropriately trained palliative care clinicians is important for people with high levels of physical or psychological concerns, irrespective of the care setting or diagnosis. J Am Geriatr Soc 68:1825-1833, 2020.
（1）描述在入住姑息治疗住院患者时被诊断为痴呆症的患者的临床特征和症状；（2）将这些与姑息治疗相关的问题的性质和严重程度与患有其他慢性疾病的患者进行比较。
使用即时护理结果评估数据进行描述性研究（2013 年 1 月 1 日至 2018 年 12 月 31 日）。
共 129 家参与澳大利亚姑息治疗结果协作的姑息治疗住院服务机构。
共 29971 名主要诊断为痴呆症（n=1872）、肺癌（n=19499）、心血管疾病（CVD，n=5079）、中风（n=2659）或运动神经元病（MND，n=862）的患者。
本研究报告了在入住姑息治疗住院服务机构时收集的数据，包括患者自评的七种常见躯体症状的痛苦程度、临床医生评估的症状严重程度、功能依赖程度和表现状态。分析的其他数据包括入院次数、住院时间和姑息治疗阶段。
与肺癌、CVD 和 MND 患者相比，在入住姑息治疗住院服务机构时，痴呆症患者的大多数症状痛苦程度较低（比值比范围为 0.15 至 0.80；所有 P 值均 <.05），但功能障碍程度较高（比值比范围为 3.02 至 8.62；所有 P 值均 <.001），他们需要更多的基本日常生活活动帮助（比值比范围为 3.83 至 12.24；所有 P 值均 <.001）。与中风患者相比，这些趋势大多呈相反方向。痴呆症患者接受姑息治疗的时间晚于肺癌和 MND 患者。
在决定为每个个体提供最佳护理地点时，需要考虑到痴呆症患者所经历的独特的姑息治疗问题模式以及相关卫生服务的技能。无论护理环境或诊断如何，获得经过适当培训的姑息治疗临床医生对那些存在高度躯体或心理问题的患者都很重要。美国老年医学会杂志 68：1825-1833，2020。
