Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
J Am Geriatr Soc. 2021 Feb;69(2):450-458. doi: 10.1111/jgs.16871. Epub 2020 Nov 3.
To describe changes in the occurrence of restricting symptoms at the end of life from 1998 to 2019 and compare these changes according to the condition leading to death.
Prospective longitudinal study.
Greater New Haven, CT.
A total of 665 decedents from a cohort of 754 community-living persons, 70 years or older.
The occurrence of 16 restricting symptoms was ascertained during monthly interviews. Information on the conditions leading to death was obtained from death certificates and comprehensive assessments that were completed every 18-months. For each restricting symptom, adjusted rates (per 100 person-months) were calculated separately for six multiyear time intervals.
From 1998 to 2019, rates decreased for five (31.3%) restricting symptoms (difficulty sleeping; chest pain or tightness; shortness of breath; cold or flu symptoms; and nausea, vomiting, or diarrhea), increased for three (18.8%: arm or leg weakness; urinary incontinence; and memory or thinking problem), and changed little for the other eight (50.0%: poor eyesight; anxiety; depression; musculoskeletal pain; fatigue; dizziness or unsteadiness; frequent or painful urination; and swelling in feet or ankles). The decrease in rates was most pronounced for shortness of breath, with a reduction from 15.0 (95% credible interval = 11.7-18.6) in 1998 to 2001 to 8.2 (95% credible interval = 5.9-10.5) in 2014 to 2019, yielding a rate ratio (95% credible interval) of 0.92 (0.86-0.98). When evaluated according to the condition leading to death, the results were similar, with 10 of the 13 statistically significant rate ratios representing decreases in rates over time and only 3 representing increases.
The occurrence of most restricting symptoms at the end of life has been decreasing or stable over the past two decades. These results suggest that end-of-life care has been improving, although additional efforts will be needed to further reduce symptom burden at the end of life.
描述 1998 年至 2019 年临终限制症状的发生变化，并根据导致死亡的情况对这些变化进行比较。
前瞻性纵向研究。
康涅狄格州大纽黑文。
总共 665 名来自一个社区居住的 754 人队列的死者，年龄在 70 岁或以上。
在每月的访谈中确定了 16 种限制症状的发生情况。关于导致死亡的情况的信息是从死亡证明和每 18 个月完成的综合评估中获得的。对于每种限制症状，分别为六个多年时间间隔计算调整后的发生率（每 100 人-月）。
1998 年至 2019 年，五种（31.3%）限制症状（睡眠困难；胸痛或紧缩感；呼吸急促；感冒或流感症状；恶心、呕吐或腹泻）的发生率下降，三种（18.8%：手臂或腿部无力；尿失禁；记忆或思维问题）的发生率上升，其他八种（50.0%：视力不佳；焦虑；抑郁；肌肉骨骼疼痛；疲劳；头晕或不稳定；频繁或疼痛的排尿；脚或脚踝肿胀）的发生率变化不大。呼吸急促的发生率下降最为明显，从 1998 年至 2001 年的 15.0（95%可信区间=11.7-18.6）降至 2014 年至 2019 年的 8.2（95%可信区间=5.9-10.5），发生率比（95%可信区间）为 0.92（0.86-0.98）。根据导致死亡的情况进行评估，结果相似，13 个统计学上显著的发生率比中有 10 个代表随着时间的推移发生率下降，只有 3 个代表发生率上升。
过去二十年，临终限制症状的发生情况一直在减少或保持稳定。这些结果表明，临终关怀有所改善，尽管还需要进一步努力来进一步减轻临终时的症状负担。
