养老院中晚期痴呆症患者的临终关怀质量优于医院：一项瑞典全国登记研究。
Better quality of end-of-life care for persons with advanced dementia in nursing homes compared to hospitals: a Swedish national register study.
机构信息
Department of Radiation Sciences, Umeå University, SE 907 87, Umeå, Sweden.
Department of Palliative Medicine, Stockholms Sjukhem Foundation, SE 112 19, Stockholm, Sweden.
出版信息
BMC Palliat Care. 2020 Aug 26;19(1):135. doi: 10.1186/s12904-020-00639-5.
BACKGROUND
Hospitalisation of patients with advanced dementia is generally regarded as less preferable compared to care at home or in a nursing home. For patients with other diagnoses, young age has been associated with better end-of-life care. However, studies comparing the quality of palliative care for persons with advanced dementia in hospitals and nursing homes are scarce. The aim of this study was to investigate whether quality of end-of-life care for patients with dementia depends on age, gender and place of death.
METHODS
The Swedish Register of Palliative Care (SRPC) was used to identify patients who died from dementia in hospitals or nursing homes during a three-year period. The likelihood of death occurring at a hospital, based on age and gender differences, was calculated. Associations between 13 end-of-life care quality indicators collected from the SRPC and age, gender and place of care were examined in a logistic regression model.
RESULTS
Death at a hospital was associated with poorer quality of end-of-life care for 10 of the 13 measured outcomes when compared to death at a nursing home, and with better quality according to two of the outcomes. Death at a hospital was more common for men compared to women and for younger patients compared to older. Receiving fluids intravenously or via enteral tube in the last 24 h of life was strongly associated with death at a hospital. Women were more likely to have their oral health assessed and less likely to have pressure ulcers at death. Eight of 12 end-of-life care outcomes showed better results for the age group 65 to 84 years compared to those 85 years or older.
CONCLUSIONS
Death in hospitals was associated with poorer quality of end-of-life care compared to death in nursing homes. Our data support the importance of advance care planning and individual assessments in nursing homes to avoid referral to hospitals during end of life. Despite established recommendations to avoid hospitalisation if possible, there were strong associations between younger age, male gender and hospitalisation in the end of life. Further studies are needed to investigate the role of socioeconomic factors in end-of-life care for this patient group.
背景
与在家中或养老院接受护理相比，一般认为患有晚期痴呆症的患者住院治疗不太可取。对于其他诊断的患者，年轻的年龄与临终关怀的改善有关。然而，比较医院和养老院中晚期痴呆症患者姑息治疗质量的研究很少。本研究旨在调查痴呆症患者临终关怀质量是否取决于年龄、性别和死亡地点。
方法
使用瑞典姑息治疗登记处（SRPC）来识别在三年内死于医院或养老院的痴呆症患者。根据年龄和性别差异，计算在医院死亡的可能性。使用来自 SRPC 的 13 个临终关怀质量指标与年龄、性别和护理地点之间的关联，在逻辑回归模型中进行了检查。
结果
与在养老院死亡相比，在医院死亡与 13 个测量结果中的 10 个结果的临终关怀质量较差相关，与 2 个结果的临终关怀质量较好相关。与女性相比，男性和年轻患者在医院死亡的可能性更大。在生命的最后 24 小时内静脉或通过肠内管给予液体与在医院死亡密切相关。女性更有可能评估口腔健康，而在死亡时不太可能出现压疮。12 个临终关怀结果中有 8 个在 65 至 84 岁年龄组的结果优于 85 岁或以上年龄组。
结论
与在养老院死亡相比，在医院死亡与临终关怀质量较差相关。我们的数据支持在养老院进行预先护理计划和个体评估的重要性，以避免在生命末期转至医院。尽管有既定的建议尽可能避免住院治疗，但在生命末期，年轻、男性和住院之间存在很强的关联。需要进一步研究社会经济因素在该患者群体临终关怀中的作用。
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