Who dies at home? Determinants of site of death for community-based long-term care patients
Who dies at home? Determinants of site of death for community-based long-term care patients
复制标题
DOI：
10.1111/j.1532-5415.1999.tb01897.x
复制
发表时间：
1999-01-01
影响因子：
6.3
通讯作者：
Tinetti, ME
中科院分区：
文献类型：
--
作者：
Fried, TR;Pollack, DM;Tinetti, ME
目的：确定长期家庭护理患者队列中与死亡部位相关的特征。设计：队列研究。环境：社区长期护理项目。对象：1989 - 1990年间入院1年内死亡的65岁及以上患者。主要结局指标：死亡地点。结果：620名受试者中，302人（49%）死于医院，132人（21%）死于家庭，124人（20%）死于养老院，45人（7%）死于住院安宁疗护。在死亡前住在家中的患者中，与在家中而不是在医院或住院安宁疗护中死亡相关的因素包括女性（相对风险（RR） 1.40, 95%可信区间（CI） 1.00, 1.90）；严重依赖功能状态（RR 2.38, CI 1.39, 4.17）和认知状态（RR 1.51, CI 1.10, 2.06）；死于癌症（RR 1.68, CI 1.11, 2.55）、慢性肺部疾病（AOR 1.75, CI 1.04, 2.95）或冠状动脉疾病（RR 1.93, CI 1.21, 3.09）。与孩子同住(RR 1.45， CI。99, 2.11)显示出与在家死亡相关的趋势。结论：即使在接受社区长期护理的老年人亚组中，家中死亡的频率也很低。功能、社会和疾病状态与死亡地点之间的关联表明，必须检查这些因素与患者偏好和护理需求之间的关系，以便了解如何优化临终护理地点。
OBJECTIVE: To determine characteristics associated with site of death in a cohort of long-term homecare patients.DESIGN: Cohort study.SETTING: Community-based long-term care program.SUBJECTS: All patients 65 years of age or older who died within 1 year of admission during 1989 and 1990.MAIN OUTCOME MEASURE: Site of death.RESULTS: Of 620 subjects, site of death was hospital for 302 (49%), home for 132 (21%), nursing home for 124 (20%), and inpatient hospice for 45 (7%). Among patients living at home before death, factors associated with dying at home rather than in a hospital or inpatient hospice included female gender (relative risk (RR) 1.40, 95% confidence interval (CI) 1.00, 1.90); severely dependent functional status (RR 2.38, CI 1.39, 4.17) and cognitive status (RR 1.51, CI 1.10, 2.06); and dying of cancer (RR 1.68, CI 1.11, 2.55), chronic lung disease (AOR 1.75, CI 1.04, 2.95), or coronary artery disease (RR 1.93, CI 1.21, 3.09). Living with a child (RR 1.45, CI .99, 2.11) showed a trend toward association with dying at home.CONCLUSIONS: Even among a subgroup of older persons receiving community-based long-term care, the frequency of home death is low. The finding of an association between functional, social, and disease status and site of death suggests that the relationship between these factors and patients' preferences and care needs must be examined in order to understand how to optimize the site of terminal care.