Prevalence, effectiveness, and predictors of planning the place of death among older persons followed in community-based long term care
Prevalence, effectiveness, and predictors of planning the place of death among older persons followed in community-based long term care
复制标题
DOI：
10.1111/j.1532-5415.2000.tb06892.x
复制
发表时间：
2000-08-01
影响因子：
6.3
通讯作者：
Remsburg, R
中科院分区：
文献类型：
--
作者：
Leff, B;Kaffenbarger, KP;Remsburg, R
背景：很少有人知道患者是否计划他们的死亡地点，以及这种计划是否有效。目的：确定在社区为基础的、由医生领导的出诊计划中计划死亡地点的老年人中计划死亡地点的流行率、有效性和预测因素。设计：回顾图表回顾。设置：巴尔的摩东南部的一个地理定义的集水区，方法：对1995年7月至1998年11月间死亡的125例患者进行由医生指导的出诊计划的跟踪调查。主要观察指标：有无特定地点死亡计划，且计划死亡地点与实际死亡地点一致。结果：80例患者(%)制定了特定地点死亡计划，73例(91%)死亡计划执行成功。从制定在特定地点死亡的计划到死亡的中位数时间为36天。Logistic回归分析显示，计划在特定地点死亡与预先指示不复苏(DNR)呈正相关(优势比(OR)11.7，可信区间(CI)3.7，32.5)，与除居家外缺乏可识别的主要疾病呈负相关(OR 0.17；CI，0.02~0.88)。结论：在居住在社区的一群体弱老年人中，计划在特定地点死亡是常见的，且大部分时间都能成功实施。在家中提供医生护理可能有助于改善对老年人的临终护理。
BACKGROUND: Little is known about whether patients plan for the site of their death and whether such planning is effective.OBJECTIVE: To determine the prevalence, effectiveness, and predictors of planning the place of death among older homebound persons followed in a community-based, physician-led house call program.DESIGN: Retrospective chart review.SETTING: A geographically defined catchment area in southeast Baltimore, Maryland.PATIENTS: One hundred twenty-five patients who died between July 1995 and November 1998 who were followed in a physician-led house call program.MAIN OUTCOME MEASURES: Presence of a plan to die in a specific place and concordance between planned and actual place of death.RESULTS: Eighty patients (64%) made a plan to die in a specific place, and these plans were executed successfully in 73 cases (91%). The median time between formulating a plan to die in a specific place and death was 36 days. In logistic regression analysis, making a plan to die in a specific place was positively associated with an advance directive of Do Not Resuscitate (DNR) (odds ratio (OR) 11.7, confidence interval (CI) 3.7, 32.5) and negatively associated with the lack of an identifiable main medical problem other than being homebound (OR 0.17; CI, 0.02-0.88).CONCLUSIONS: Among a group of frail older persons living in the community, planning to die in a particular place was common and implemented successfully most of the time. Providing physician care at home may facilitate improved end-of-life care for older persons.