Division of Geriatrics, Department of Internal Medicine, Duke School of Medicine, Durham, North Carolina, USA.
Center for Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA.
J Am Geriatr Soc. 2020 Sep;68(9):2027-2033. doi: 10.1111/jgs.16521. Epub 2020 May 16.
BACKGROUND/OBJECTIVES: Acute hospitalization may be an ideal opportunity to introduce palliative care to dementia patients, who may benefit from symptom management and goals of care discussions. We know little about patients who receive inpatient palliative care consultations (IPCCs).
Retrospective analysis using electronic medical record.
Tertiary academic medical center and affiliated community hospital.
Patients with dementia by International Classification of Diseases diagnosis, 65 years or older, hospitalized between July 1, 2015, and December 31, 2015.
We used χ and t-test/Mann-Whitney U test to compare characteristics (living arrangement, advanced dementia markers, diagnoses of delirium and dementia with behavior disturbance, and admitting diagnosis) and outcomes (change in code status, length of stay [LOS], discharge disposition, and discharge medications for symptom management) of patients who did and did not receive IPCC. Patients were matched on sex, age, and race.
Among 927 hospitalized patients with dementia, 17% received IPCC (N = 157). Patients who received IPCC were more likely to be admitted from a nursing facility (35.7% vs 12.7%; P < .0001), experience delirium (71.3% vs 57.3%; P = .01), have behavior disturbance (23.6% vs 13.4%; P = .02), have a pressure ulcer at admission (26.1% vs 11.5%; P = .001), have hypernatremia (12.7% vs 3.2%; P = .002), and be bedbound (20.4% vs 3.2%; P < .000). Patients who received IPCC had a longer LOS (median = 5.9 vs 4.3 days; P = .004) and were more likely to be discharged to hospice (56% vs 3.1%; P < .0001). Patients with IPCC were more likely to have a discharge code status of do not attempt resuscitation (89% vs 46%). There was no significant difference in comfort medications at discharge between groups.
Patients who received IPCC had evidence of more advanced dementia. These patients were more likely to change their code status and enroll in hospice. IPCC may be useful to prioritize patient-centered care and discuss what matters most to patients and families.
背景/目的：急性住院治疗可能是为痴呆患者引入姑息治疗的理想时机，他们可能从症状管理和护理目标讨论中受益。我们对接受住院姑息治疗咨询（IPCC）的患者知之甚少。
使用电子病历进行回顾性分析。
三级学术医疗中心和附属社区医院。
2015 年 7 月 1 日至 12 月 31 日期间，国际疾病分类诊断为痴呆症且年龄在 65 岁或以上的住院患者。
我们使用 χ 和 t 检验/曼-惠特尼 U 检验比较了接受和未接受 IPCC 的患者的特征（居住安排、晚期痴呆标志物、谵妄和伴有行为障碍的痴呆症诊断、入院诊断）和结果（更改代码状态、住院时间[LOS]、出院安置、以及用于症状管理的出院药物）。患者在性别、年龄和种族方面进行匹配。
在 927 名患有痴呆症的住院患者中，有 17%（N=157）接受了 IPCC。接受 IPCC 的患者更有可能从护理机构入院（35.7%对 12.7%；P<.0001）、出现谵妄（71.3%对 57.3%；P=.01）、出现行为障碍（23.6%对 13.4%；P=.02）、入院时患有压疮（26.1%对 11.5%；P=.001）、高钠血症（12.7%对 3.2%；P=.002）和卧床不起（20.4%对 3.2%；P<.0001）。接受 IPCC 的患者 LOS 更长（中位数=5.9 对 4.3 天；P=.004），更有可能被送往临终关怀（56%对 3.1%；P<.0001）。接受 IPCC 的患者更有可能出院时的复苏尝试代码状态为不复苏（89%对 46%）。两组出院时的舒适药物无显著差异。
接受 IPCC 的患者有更晚期痴呆的证据。这些患者更有可能改变他们的代码状态并参加临终关怀。IPCC 可能有助于确定以患者为中心的护理优先级，并讨论对患者和家属最重要的事情。
