Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, New York, USA.
Department of Psychiatry, University of Rochester School of Medicine and Dentistry, New York, USA.
Gerontologist. 2021 Nov 15;61(8):1296-1306. doi: 10.1093/geront/gnaa188.
Nursing homes (NHs) care for 70% of Americans dying with dementia. Many consider deaths in NHs rather than hospitals as preferable for most of these residents. NH characteristics such as staff teamwork, communication, and other components of patient safety culture (PSC), together with state minimum NH nurse staffing requirements, may influence location of death. We examined associations between these variables and place of death (NH/hospital) among residents with dementia.
Cross-sectional study of 11,957 long-stay NH residents with dementia, age 65+, who died in NHs or hospitals shortly following discharge from one of 800 U.S. NHs in 2017. Multivariable logistic regression systematically estimated effects of PSC on odds of in-hospital death among residents with dementia, controlling for resident, NH, county, and state characteristics. Logistic regressions also determined moderating effects of state minimum NH nurse staffing requirements on relationships between key PSC domains and location of death.
Residents with dementia in NHs with higher PSC scores in communication openness had lower odds of in-hospital death. This effect was stronger in NHs located in states with higher minimum NH nurse staffing requirements.
Promoting communication openness in NHs across nursing disciplines may help avoid unnecessary hospitalization at the end of life, and merits particular attention as NHs address nursing staff mix while adhering to state staffing requirements. Future research to better understand unintended consequences of staffing requirements is needed to improve end-of-life care in NHs.
养老院（NH）照顾着 70%患有痴呆症的美国人。许多人认为，对于这些居民中的大多数来说，在 NH 而不是医院去世更为理想。NH 的特点，如员工团队合作、沟通以及患者安全文化（PSC）的其他组成部分，以及州对 NH 护士最低配置要求，可能会影响死亡地点。我们研究了这些变量与痴呆症患者死亡地点（NH/医院）之间的关系。
这是一项对 2017 年从美国 800 家 NH 中的一家出院后不久在 NH 或医院去世的 11957 名长期居住的 NH 痴呆症居民的横断面研究。多变量逻辑回归系统地估计了 PSC 对痴呆症居民住院死亡几率的影响，同时控制了居民、NH、县和州的特征。逻辑回归还确定了州对 NH 最低护士配置要求对关键 PSC 领域与死亡地点之间关系的调节作用。
在沟通开放度方面具有更高 PSC 评分的 NH 中的痴呆症居民，其住院死亡的几率较低。这一效果在 NH 位于护士最低配置要求较高的州时更为明显。
在整个护理学科中促进 NH 中的沟通开放可能有助于避免生命末期不必要的住院治疗，并且在 NH 遵守州的人员配置要求的同时，需要特别注意护理人员的组合，这一点尤其值得关注。需要进一步研究以更好地了解人员配置要求的意外后果，从而改善 NH 的临终关怀。
