Changes in Care Goals and Treatment Orders Around the Occurrence of Health Problems and Hospital Transfers in Dementia: A Prospective Study
Changes in Care Goals and Treatment Orders Around the Occurrence of Health Problems and Hospital Transfers in Dementia: A Prospective Study
复制标题
DOI：
10.1111/jgs.14667
复制
发表时间：
2017-04-01
影响因子：
6.3
通讯作者：
van der Steen, Jenny T.
中科院分区：
文献类型：
--
作者：
Hendriks, Simone A.;Smalbrugge, Martin;van der Steen, Jenny T.
目的探讨在发生肺炎和摄入问题时护理目标和治疗顺序的变化，以及住院治疗是否符合先前商定的不住院治疗顺序。设计数据收集作为荷兰老年痴呆症生命结束研究的一部分（2007-2011年），一项长达3.5年随访的纵向观察性研究。设置荷兰长期护理机构（N = 28）。每半年，医生完成关于护理目标和治疗顺序的问卷调查，他们不断记录肺炎发作、摄入问题和住院情况。我们报告的变化，在后续的发展中的肺炎和摄入量的问题，住院治疗和住院原因的护理目标和治疗订单。结果姑息治疗的目标和不治疗订单的患者的比例上升，在后续行动中，特别是在死亡之前。最常见的治疗命令是复苏和住院（禁止命令分别从73%增加到92%和从28%增加到76%）。在发生肺炎后，有姑息治疗目标和不治疗命令的患者比例相似，但在摄入问题后增加。随访期间，46例患者住院一次或多次。在21%的决定中，尽管有不住院的命令，但仍发生住院。住院治疗的最常见的原因是骨折，特别是在患者不住院order.ConclusionCare计划，包括全球护理目标（主要是姑息治疗目标），入院后不久，具体的治疗订单商定更详细的条件时，病人的。在疗养院入院后不久制定护理计划可能有助于防止繁重的治疗。
ObjectivesTo explore changes in care goals and treatment orders around the occurrence of pneumonia and intake problems, and whether hospitalization is in line with earlier agreed-upon do-not-hospitalize orders.DesignData were collected as part of the Dutch End of Life in Dementia study (2007-2011), a longitudinal observational study with up to 3.5 years of follow-up.SettingLong-term care facilities (N = 28) in the Netherlands.ParticipantsNewly admitted nursing home patients (N = 372) in various stages of dementia.MeasurementsSemiannually, physicians completed questionnaires about care goals and treatment orders, and they continuously registered episodes of pneumonia, intake problems and hospitalization. We report on changes in care goals and treatment orders during follow-up in relation to the developing of pneumonia and intake problems and on hospitalization and reasons for hospitalization.ResultsThe proportion of patients with palliative care goals and do-not-treat orders rose during follow-up, especially before death. Treatment orders most frequently referred to resuscitation and hospitalization (do-not order increased from 73% to 92%, and from 28% to 76%, respectively). The proportions of patients with a palliative care goal and do-not-treat orders were similar after developing pneumonia, but increased after intake problems. During follow-up, 46 patients were hospitalized one or more times. Hospitalization occurred despite a do-not-hospitalize order in 21% of decisions. The most frequently reported reason for hospitalization was a fracture, especially in patients with a do-not-hospitalize order.ConclusionCare plans, including global care goals (predominantly palliative care goals), are made soon after admission, and specific treatment orders are agreed upon in more detail when the condition of the patient worsens. Establishing care plans shortly after nursing home admission may help to prevent burdensome treatment.