Shandong Xiehe University, Jinan, Shandong, China.
Monash Nursing and Midwifery, Monash University, Melbourne, Vic, Australia.
BMC Palliat Care. 2024 Sep 4;23(1):219. doi: 10.1186/s12904-024-01545-w.
Most people diagnosed with dementia live and die in community settings. This study aimed to: (i) describe the palliative care needs of patients with dementia at commencement of community palliative care; (ii) compare palliative care needs between patients with dementia and those with lung cancer and cardiovascular disease (CVD).
This is a population-based descriptive study that involved 8,727, 7,539 and 25,279 patients who accessed community palliative care across Australia principally because of dementia, CVD and lung cancer. Patients' functional abilities, symptom burden and clinical condition were assessed at commencement of community alliative care using five validated instruments: Resource Utilisation Groups-Activities of Daily Living, Australia-modified Karnofsky Performance Status, Symptoms Assessment Scale, Palliative Care Problem Severity Score and Palliative Care Phase. We fitted ordinal logistic regression models to examine the differences in these assessments for dementia versus CVD and lung cancer, respectively.
Overall, patients with dementia generally had low levels of distress from symptoms but poor functional problems. Compared to the other two diagnostic groups, palliative care for dementia was often initiated later and with shorter contacts. Also, patients with dementia presented with poorer functional performance (adjusted OR (aOR) = 4.02, Confidence Interval (CI): 3.68 - 4.38 for dementia vs CVD; aOR = 17.59, CI: 15.92 - 19.44 for dementia vs lung cancer) and dependency (aOR = 5.68, CI: 5.28 - 6.12 for dementia vs CVD; aOR = 24.97, CI: 22.77 - 27.39 for dementia vs lung cancer), but experienced lower levels of distress and problem severity for the majority of symptoms.
Community palliative care is often an ideal care option for many patients, particularly for those with dementia. We call for expansion of the palliative care workforce and options for home care support to optimize accessibility of community palliative care for dementia.
大多数被诊断为痴呆症的人都在社区环境中生活和死亡。本研究旨在：（i）描述开始社区姑息治疗时痴呆症患者的姑息治疗需求；（ii）比较痴呆症患者与肺癌和心血管疾病（CVD）患者的姑息治疗需求。
这是一项基于人群的描述性研究，涉及 8727 名、7539 名和 25279 名在澳大利亚主要因痴呆症、CVD 和肺癌而接受社区姑息治疗的患者。使用五种经过验证的工具评估患者开始社区alliative 治疗时的功能能力、症状负担和临床状况：资源利用组-日常生活活动、澳大利亚改良 Karnofsky 表现状态、症状评估量表、姑息治疗问题严重程度评分和姑息治疗阶段。我们拟合了有序逻辑回归模型，分别检查这些评估结果在痴呆症与 CVD 和肺癌之间的差异。
总体而言，痴呆症患者的症状困扰程度通常较低，但功能问题较差。与其他两个诊断组相比，痴呆症患者的姑息治疗往往开始较晚，接触时间较短。此外，痴呆症患者的功能表现较差（调整后的优势比（aOR）=4.02，置信区间（CI）：3.68-4.38 痴呆症与 CVD 相比；aOR=17.59，CI：15.92-19.44 痴呆症与肺癌相比）和依赖程度较高（aOR=5.68，CI：5.28-6.12 痴呆症与 CVD 相比；aOR=24.97，CI：22.77-27.39 痴呆症与肺癌相比），但大多数症状的困扰程度和问题严重程度较低。
社区姑息治疗通常是许多患者的理想治疗选择，特别是对痴呆症患者。我们呼吁扩大姑息治疗人员队伍，并提供家庭护理支持选项，以优化社区姑息治疗对痴呆症的可及性。
