Kim Su Hyun
Research Institute of Nursing Science, College of Nursing, Kyungpook National University, Gukchaebosang-ro 680, Daegu 41944, Korea.
Int J Environ Res Public Health. 2022 Mar 25;19(7):3924. doi: 10.3390/ijerph19073924.
A comprehensive plan has been launched by the Korean government to expand hospice and palliative care from hospital-based inpatient units to other services, such as palliative care at home, palliative consultation, and palliative care at a nursing home.
To examine the illnesses and symptoms at the end of life associated with the place of death among older Korean adults.
This secondary data analysis included a stratified random sample of 281 adults identified from the exit survey of the Korean Longitudinal Study of Aging aged ≥65 years and who died in 2017-2018.
Overall, 69% of the patients died at hospitals, 13% died at long-term care facilities (LTCF), and 18% died at home. In the multinomial logistic regression analysis adjusting for age, sex, and marital status, older adults who died in the hospital had higher odds (2.02-4.43 times) of having limitations in activities of daily living (ADL) as well as symptoms of anorexia, depression, weakness, dyspnea, and periodic confusion 1 month before death than those who died at home. Older adults who died in an LTCF were more likely to have limitations in ADL and instrumental ADL as well as a higher likelihood (2-5 times) of experiencing pain, anorexia, fatigue, depression, weakness, dyspnea, incontinence, periodic confusion, and loss of consciousness than those who died at home.
Since the majority of subjects died either in a hospital or an LCTF, and this proportion is expected to increase, policy planning should focus on improving the palliative case in these settings. Future policies and clinical practices should consider the illness and symptoms of older patients at the end of life across different care settings.
韩国政府已启动一项全面计划，将临终关怀和姑息治疗从医院住院单元扩展到其他服务，如居家姑息治疗、姑息咨询和养老院姑息治疗。
研究韩国老年成年人的死亡地点与临终疾病和症状之间的关系。
这项二次数据分析纳入了一个分层随机样本，样本来自对年龄≥65岁且于2017 - 2018年死亡的韩国老年纵向研究的退出调查中确定的281名成年人。
总体而言，69%的患者在医院死亡，13%在长期护理机构（LTCF）死亡，18%在家中死亡。在对年龄、性别和婚姻状况进行调整的多项逻辑回归分析中，与在家中死亡的老年人相比，在医院死亡的老年人在死亡前1个月日常生活活动（ADL）受限以及出现厌食、抑郁、虚弱、呼吸困难和周期性意识模糊症状的几率更高（2.02 - 4.43倍）。在LTCF死亡的老年人比在家中死亡的老年人更有可能在ADL和工具性ADL方面受限，并且经历疼痛、厌食、疲劳、抑郁、虚弱、呼吸困难、失禁、周期性意识模糊和意识丧失的可能性更高（2 - 5倍）。
由于大多数受试者在医院或LCTF死亡，且这一比例预计会增加，政策规划应侧重于改善这些环境中的姑息治疗情况。未来的政策和临床实践应考虑不同护理环境下老年患者临终时的疾病和症状。
