Department of Family Medicine, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan.
Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan.
Medicine (Baltimore). 2022 Jul 29;101(30):e29630. doi: 10.1097/MD.0000000000029630.
The quality of end-of-life (EOL) care for patients receiving home-based care is a critical issue for health care providers. Dying in a preferred place is recognized as a key EOL care quality indicator. We explore the factors associated with death at home or nursing facilities among elderly patients receiving home-based care. This retrospective study was based on a medical chart review between January 2018 and December 2019 of elderly patients. Multivariate analysis was conducted by fitting multiple logistic regression models with the stepwise variable selection procedure to explore the associated factors. The 205 elderly patients receiving home-based care were enrolled for analysis. The mean participant age was 84.2 ± 7.8 years. Multiple logistic regression indicated that significant factors for elderly home-based patients who died at home or nursing facilities were receiving palliative service (odds ratio [OR], 3.21; 95% confidence interval [CI], 1.37-7.51; P = .007), symptoms of nausea or vomiting (OR, 5.38; 95% CI, 1.12-25.84; P = .036), fewer emergency department visits (OR, 0.07; 95% CI, 0.03-0.16; P < .001), and less intravenous third-generation cephalosporin use (OR, 0.15; 95% CI, 0.03-0.75; P = .021) in the last month of life. Patients with dementia had a lower probability of dying at home or nursing facilities than patients with other diagnosis (OR, 0.34, 95% CI, 0.13-0.90; P = .030). Among elderly home-based patients, receiving palliative service, with nausea or vomiting, and fewer emergency department visits in the last month of life favored home or nursing facilities deaths. Practitioners should be aware of the factors with higher probabilities of dying at home and in nursing facilities. We suggested that palliative services need to be further developed and extended to ensure that patients with dementia can receive adequate EOL care at home and in nursing facilities.
居家临终关怀患者的临终关怀质量是医疗服务提供者关注的一个关键问题。在首选地点去世被认为是临终关怀质量的一个关键指标。我们探讨了与居家临终关怀老年患者在家中或护理机构死亡相关的因素。这项回顾性研究基于 2018 年 1 月至 2019 年 12 月期间对接受居家临终关怀的老年患者的病历回顾。采用逐步变量选择程序拟合多变量逻辑回归模型进行多变量分析，以探讨相关因素。共纳入 205 例接受居家临终关怀的老年患者进行分析。参与者的平均年龄为 84.2±7.8 岁。多变量逻辑回归表明，居家临终关怀老年患者在家中或护理机构死亡的显著因素是接受姑息治疗（优势比 [OR]，3.21；95%置信区间 [CI]，1.37-7.51；P=0.007）、恶心或呕吐症状（OR，5.38；95%CI，1.12-25.84；P=0.036）、较少急诊就诊（OR，0.07；95%CI，0.03-0.16；P<0.001）和较少使用第三代静脉头孢菌素（OR，0.15；95%CI，0.03-0.75；P=0.021）。在生命的最后一个月。痴呆患者在家中或护理机构死亡的概率低于其他诊断患者（OR，0.34，95%CI，0.13-0.90；P=0.030）。在居家临终关怀老年患者中，生命最后一个月接受姑息治疗、有恶心或呕吐症状和较少急诊就诊的患者更倾向于在家中或护理机构死亡。从业者应该意识到哪些因素会增加在家和护理机构死亡的概率。我们建议进一步发展和扩大姑息治疗服务，以确保痴呆患者能够在家中和护理机构得到充分的临终关怀。
