Johnston Bridget M, Miller Mary, Normand Charles, Cardona Magnolia, May Peter, Lowney Aoife C
Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, 3-4 Foster Place, Dublin 2, Dublin, Ireland.
Department of Palliative Care, Oxford University Hospitals NHS Foundation Trust, Oxford, England.
BMC Palliat Care. 2024 Feb 20;23(1):46. doi: 10.1186/s12904-024-01384-9.
Older people account heavily for palliative care needs at the population level and are growing in number as the population ages. There is relatively little high-quality data on symptom burden and quality of life, since these data are not routinely collected, and this group are under-recruited in primary research. It is unclear which measurement tools are best suited to capture burdens and experience.
We recruited a cohort of 221 patients aged 75 + years with poor prognosis who had an unplanned admission via the emergency department in a large urban hospital in England between 2019 and 2020. Risk of dying was assessed using the CriSTAL tool. We collected primary data and combined these with routine health records. Baseline clinical data and patient reported quality of life outcomes were collected on admission and reassessed within the first 72 h of presentation using two established tools: EQ-5D-5 L, EQ-VAS and the Integrated Palliative Outcomes Scale (IPOS).
Completion rate was 68% (n = 151) and 33.1% were known to have died during admission or within 6 months post-discharge. The vast majority (84.8%) reported severe difficulties with at least one dimension of EQ-5D-5 L at baseline and improvements in EQ-VAS observed at reassessment in 51.7%. The baseline IPOS revealed 78.2% of patients rating seven or more items as moderate, severe or overwhelming, but a significant reduction (-3.6, p < 0.001) in overall physical symptom severity and prevalence was also apparent. No significant differences were noted in emotional symptoms or changes in communication/practical issues. IPOS total score at follow up was positively associated with age, having comorbidities (Charlson index score > = 1) and negatively associated with baseline IPOS and CriSTAL scores.
Older people with poor prognosis admitted to hospital have very high symptom burden compared to population norms, though some improvement following assessment was observed on all measures. These data provide valuable descriptive information on quality of life among a priority population in practice and policy and can be used in future research to identify suitable interventions and model their effects.
在总体层面上，老年人在姑息治疗需求中占比很大，并且随着人口老龄化，其数量正在增加。关于症状负担和生活质量的高质量数据相对较少，因为这些数据并非常规收集，而且该群体在初级研究中的招募不足。目前尚不清楚哪种测量工具最适合捕捉负担和体验。
我们招募了一组221名年龄在75岁及以上、预后较差的患者，他们于2019年至2020年期间在英国一家大型城市医院通过急诊科非计划入院。使用CriSTAL工具评估死亡风险。我们收集了原始数据，并将其与常规健康记录相结合。入院时收集基线临床数据和患者报告的生活质量结果，并在就诊后的前72小时内使用两种既定工具进行重新评估：EQ-5D-5L、EQ-VAS和综合姑息治疗结果量表（IPOS）。
完成率为68%（n = 151），已知33.1%的患者在入院期间或出院后6个月内死亡。绝大多数（84.8%）患者在基线时报告在EQ-5D-5L的至少一个维度上存在严重困难，51.7%的患者在重新评估时观察到EQ-VAS有所改善。基线IPOS显示，78.2%的患者将七个或更多项目评为中度、重度或极其严重，但总体身体症状严重程度和患病率也有显著降低（-3.6，p < 0.001）。在情绪症状或沟通/实际问题的变化方面未发现显著差异。随访时的IPOS总分与年龄、患有合并症（Charlson指数评分 >= 1）呈正相关，与基线IPOS和CriSTAL评分呈负相关。
与总体标准相比，入院的预后较差的老年人症状负担非常高，不过在所有测量指标上评估后都观察到了一些改善。这些数据为实践和政策中重点人群的生活质量提供了有价值的描述性信息，可用于未来的研究以确定合适的干预措施并模拟其效果。
