当老年患者因急性老年评估被转至急诊科时的维持生命治疗偏好：荷兰医院的一项描述性研究。
Life-sustaining treatment preferences in older patients when referred to the emergency department for acute geriatric assessment: a descriptive study in a Dutch hospital.
机构信息
Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, PO Box 9101, Nijmegen, HB, 6500, The Netherlands.
Department of Pulmonology, Rijnstate, Arnhem, The Netherlands.
出版信息
BMC Geriatr. 2021 Jan 14;21(1):58. doi: 10.1186/s12877-020-02002-y.
BACKGROUND
In many cases, life-sustaining treatment preferences are not timely discussed with older patients. Advance care planning (ACP) offers medical professionals an opportunity to discuss patients' preferences. We assessed how often these preferences were known when older patients were referred to the emergency department (ED) for an acute geriatric assessment.
METHODS
We conducted a descriptive study on patients referred to the ED for an acute geriatric assessment in a Dutch hospital. Patients were referred by general practitioners (GPs), or in the case of nursing home residents, by elderly care physicians. The referring physician was asked if preferences regarding life-sustaining treatments were known. The primary outcome was the number of patients for whom preferences were known. Secondary outcomes included which preferences, and which variables predict known preferences.
RESULTS
Between 2015 and 2017, 348 patients were included in our study. At least one preference regarding life-sustaining treatments was known at referral in 45.4% (158/348) cases. In these cases, cardiopulmonary resuscitation (CPR) policy was always included. Preferences regarding invasive ventilation policy and ICU admission were known in 17% (59/348) and 10.3% (36/348) of the cases respectively. Known preferences were more frequent in cases referred by the elderly care physician than the GP (P < 0.001).
CONCLUSIONS
In less than half the patients, at least one preference regarding life-sustaining treatments was known at the time of referral to the ED for an acute geriatric assessment; in most cases it concerned CPR policy. We recommend optimizing ACP conversations in a non-acute setting to provide more appropriate, desired, and personalized care to older patients referred to the ED.
背景
在许多情况下，并未及时与老年患者讨论维持生命的治疗方案。预先医疗指示（ACP）为医疗专业人员提供了一个讨论患者偏好的机会。我们评估了在将老年患者转至急诊科（ED）进行急性老年评估时，这些偏好被了解的频率。
方法
我们对荷兰一家医院急诊科转来的急性老年评估患者进行了一项描述性研究。患者由全科医生（GP）转来，或在养老院居民的情况下由老年科医生转来。转来的医生被问及是否了解与维持生命的治疗相关的偏好。主要结局是了解偏好的患者数量。次要结局包括了解了哪些偏好，以及哪些变量可以预测了解偏好。
结果
在 2015 年至 2017 年间，我们纳入了 348 名患者。在 45.4%（158/348）的病例中，在转来急诊科时至少了解到一种与维持生命的治疗相关的偏好。在这些情况下，心肺复苏（CPR）政策总是包括在内。在 348 例患者中，17%（59/348）和 10.3%（36/348）分别了解到了有创通气政策和 ICU 入院的偏好。与由老年科医生转来的病例相比，由 GP 转来的病例中了解到偏好的情况更为常见（P<0.001）。
结论
在不到一半的患者中，在将患者转至 ED 进行急性老年评估时，至少了解到一种与维持生命的治疗相关的偏好；在大多数情况下，涉及 CPR 政策。我们建议在非急性环境中优化 ACP 对话，以为转至 ED 的老年患者提供更合适、期望和个性化的护理。
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