临终痴呆养老院居民姑息治疗的意义与实践。
Meaning and practice of palliative care for nursing home residents with dementia at end of life.
作者信息
Powers Bethel Ann, Watson Nancy M
机构信息
Elaine C. Hubbard Center for Clinical Nursing Research on Aging, University of Rochester School of Nursing, Rochester, New York 14642, USA.
出版信息
Am J Alzheimers Dis Other Demen. 2008 Aug-Sep;23(4):319-25. doi: 10.1177/1533317508316682. Epub 2008 May 4.
OBJECTIVE
To describe the meaning and practice of palliative care (PC) for nursing home (NH) residents with dementia at end of life (EOL).
DESIGN
Concurrent mixed methods (quantitative retrospective chart review and qualitative field study).
SETTING
Three NHs with varying approaches to EOL care: in-house non-Medicare hospice, Medicare hospice by outside agency, and Medicare hospice by outside agency plus specialized staff and comfort care unit.
RESULTS
Residents' course fluctuated between curative and comfort care, with a noticeable increase in symptoms right before death. Hospice care was short. Most died of complications of dementia. Families found care decisions based on residents' uncertain disease course difficult.
CONCLUSION
The role of PC for NH residents with dementia at EOL is complex and poorly understood. As they are in a residential setting, decisions need to be made about how residents live, as well as how they die, thus balancing quality of living/comfort with disease management.
目的
描述针对临终痴呆疗养院（NH）居民的姑息治疗（PC）的意义和实践。
设计
同期混合方法（定量回顾性病历审查和定性实地研究）。
设置
三家对临终关怀采取不同方法的疗养院：内部非医疗保险临终关怀、外部机构的医疗保险临终关怀、外部机构的医疗保险临终关怀加专业工作人员和舒适护理单元。
结果
居民的病程在治愈性护理和舒适护理之间波动，死亡前症状明显增加。临终关怀时间较短。大多数死于痴呆并发症。家属发现基于居民不确定病程的护理决策很困难。
结论
PC对临终痴呆NH居民的作用复杂且了解不足。由于他们处于居住环境中，需要就居民如何生活以及如何死亡做出决策，从而在生活质量/舒适度与疾病管理之间取得平衡。
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