Bárrios Helena, Nunes José Pedro Lopes, Teixeira João Paulo Araújo, Rêgo Guilhermina
Hospital do Mar Cuidados Especializados Lisboa, 2695-458 Bobadela, Portugal.
Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal.
Healthcare (Basel). 2024 Aug 8;12(16):1573. doi: 10.3390/healthcare12161573.
(1) Background: Nursing homes (NHs) face unique challenges in end-of-life care for their residents. High rates of hospitalization at the end of life are frequent, often for preventable conditions. The increased clinical uncertainty during the pandemic, the high symptom burden of the COVID-19 disease, and the challenges in communication with families and between care teams might impact the option to hospitalize NH residents at the end of life. (2) Materials and methods: The study covered a 3-year period and compared the hospitalization rates of the NH residents of a sample of Portuguese NH during the last year of life before and during the pandemic. A total of 387 deceased residents were included in the study. (3) Results: There were fewer hospitalizations in the last year of life during the pandemic period, although the proportion of deaths at hospitals was the same. Hospitalizations occurred closer to death, and with more serious clinical states. The lower rate of hospitalization was due to lower hospitalization due to infection; (4) Conclusions: The data suggest an improvement in end-of-life care practices during the pandemic period, with the decrease in hospitalizations being due to potentially burdensome hospitalizations. The importance of the role of physicians, nurses, and caregivers in this setting may be relatively independent of each other, and each may be targeted in end-of-life care training. Further study is recommended to clarify the implications of the results and if the changes can be sustained in the long term.
(1) 背景：养老院在为其居民提供临终关怀方面面临独特挑战。临终时的高住院率很常见，且往往是由可预防的状况导致。疫情期间临床不确定性增加、新冠疾病的高症状负担以及与家属和护理团队之间沟通的挑战，可能会影响养老院居民临终时住院的选择。(2) 材料与方法：该研究涵盖三年时间，比较了葡萄牙部分养老院样本中居民在疫情前和疫情期间生命最后一年的住院率。共有387名已故居民纳入研究。(3) 结果：疫情期间生命最后一年的住院次数减少，尽管在医院死亡的比例相同。住院发生在更接近死亡且临床状态更严重的时候。住院率降低是由于感染导致的住院减少；(4) 结论：数据表明疫情期间临终关怀实践有所改善，住院减少是由于可能带来负担的住院情况减少。在这种情况下，医生、护士和护理人员的角色重要性可能相对相互独立，且在临终关怀培训中可分别针对他们。建议进一步研究以阐明结果的影响以及这些变化能否长期持续。
