老年肺炎并吞咽困难患者的进食和饮水决策。
Decisions on eating and drinking in older adults admitted with pneumonia and referred for swallowing difficulties.
机构信息
Elderly Care, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Rd, London, SE18 4QH, UK.
Centre for Exercise Activity and Rehabilitation, School of Human Sciences, University of Greenwich, London, UK.
出版信息
Eur Geriatr Med. 2024 Jun;15(3):771-775. doi: 10.1007/s41999-024-00983-2. Epub 2024 May 9.
PURPOSE
Older patients with pneumonia are commonly restricted from oral intake due to concerns towards aspiration. Eating and drinking with acknowledged risks (EDAR) is a shared decision-making process emphasising patient comfort. As part of our project to find the barriers and facilitators of EDAR, we aimed for this initial study to see how frequently EDAR was selected in practice.
METHODS
We performed a retrospective cohort study at an acute hospital where EDAR was initially developed, of patients aged ≥ 75 years-old admitted with pneumonia and referred to speech and language therapy.
RESULTS
Out of 216 patients, EDAR decisions were made in 14.4%. The EDAR group had a higher 1-year mortality than the modified/normal diet groups (p < 0.001). Pneumonia recurrence rate did not differ significantly between the groups (p = 0.070).
CONCLUSION
EDAR decisions were comparatively less common and most were associated with end-of-life care. Underlying reasons for the low EDAR application rate must be investigated to maximise patient autonomy and comfort as intended by EDAR while minimising staff burden.
目的
由于担心吸入，患有肺炎的老年患者通常限制口服摄入。经认可存在风险的进食和饮水（EDAR）是一个强调患者舒适度的共同决策过程。作为我们寻找 EDAR 的障碍和促进因素的项目的一部分，我们旨在通过这项初步研究了解 EDAR 在实践中被选择的频率。
方法
我们在最初开发 EDAR 的一家急性医院进行了一项回顾性队列研究，纳入了年龄≥75 岁、因肺炎入院并转至言语和语言治疗的患者。
结果
在 216 名患者中，做出 EDAR 决策的比例为 14.4%。EDAR 组的 1 年死亡率高于改良/正常饮食组（p<0.001）。组间肺炎复发率无显著差异（p=0.070）。
结论
EDAR 决策相对较少，大多数与临终关怀相关。必须调查低 EDAR 应用率的根本原因，以最大程度地提高患者的自主性和舒适度，正如 EDAR 所预期的那样，同时最小化员工负担。
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