Hospitalization Patterns and Palliation in the Last Year of Life Among Residents in Long-Term Care
作者:Shirley S. Travis、Gary Loving、Lue McClanahan、Marie Bernard
DOI:10.1093/geront/41.2.153
日期:2001.4.1
Purpose: This study compared patterns of care, including hospitalization, during the last year of life for a group of residents in institutional long-term care. These subjects were either implicitly or explicitly in palliative care modes versus those who remained in active treatment or blended care. Design and Methods: The study used a retrospective chart review and both quantitative and qualitative methods of data collection and analysis to examine indepth the end-of-life experiences of 41 nursing home residents who died in the nursing care unit of one large continuing care retirement community during an 18-month period. Results: Most residents die in palliative care modes, but their movement into palliation with comfort care and symptom management is often slowed by indecision or inaction on the part of key decision makers, interrupted by aggressive acute care, or delayed until the last few days of life. Implications: Transitions from active curative care to palliative care are important for residents in permanent long-term care placements. Improved end-of-life care requires more attention to these transitions and to the decisions that residents, their families, and care teams are called upon to make.
目的:本研究比较了机构长期护理机构中一组居民在生命最后一年中的护理模式,包括住院治疗。这些受试者要么接受隐性或显性的姑息治疗,要么接受积极治疗或混合治疗。设计及方法:本研究采用回顾性图表审查以及定量和定性数据收集和分析方法,深入考察了41名养老院居民的生命终结体验。这些居民在18个月的时间里死于一个大型持续护理退休社区的护理单元。结果:大多数居民死于姑息治疗,但由于关键决策者的犹豫不决或无所作为,积极急性护理的介入或拖延到生命最后几天,导致他们接受姑息治疗、舒适护理和症状管理的速度减慢。启示:从积极治疗护理到姑息治疗的转变对于长期护理机构的居民来说非常重要。改善生命终结护理需要更多地关注这些转变以及居民、家属和护理团队需要做出的决定。