Use of aggressive medical treatments near the end of life: Differences between patients with and without dementia
Use of aggressive medical treatments near the end of life: Differences between patients with and without dementia
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DOI：
10.1111/j.1475-6773.2006.00608.x
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发表时间：
2007-02-01
影响因子：
3.4
通讯作者：
Yu, Wei
中科院分区：
文献类型：
--
作者：
Richardson, Samuel S.;Sullivan, Greer;Yu, Wei
目标。分析与非痴呆患者相比，痴呆症急性护理患者在临终时接受五种积极医疗服务的可能性是否更大或更小。数据来源。 1999 年 10 月 1 日至 2001 年 9 月 30 日期间死亡的全国 169,036 名 67 岁及以上 VA 用户的两年退伍军人事务部 (VA) 和医疗保险利用率数据。研究设计。我们对生命最后 30 天的急性护理出院情况进行了回顾性分析。主要结果指标是患者接受五种积极服务（入住重症监护病房 [ICU]、呼吸机、心导管插入术、肺动脉监测仪和透析）中每一种的可能性，并控制概率回归中的人口和临床因素。主要发现。在生命的最后 30 天，有 122,740 名急性住院患者出院，代表 94,100 名独特患者（31,654 名患有痴呆症）。在比较患有和不患有痴呆症的急性护理患者的 Probit 模型中，痴呆症患者入住 ICU 的可能性降低了 7.5 个百分点（95% 置信区间 [CI]，6.9-8.1；入住 ICU 的住院百分比 = 36.8%），使用呼吸机的可能性降低了 5.4 个百分点（95% CI，5.0-5.9；使用呼吸机的住院百分比 = 17.1） %），接受心导管插入术的可能性降低 0.7 个百分点（95% CI，0.6-0.8；接受心导管插入术的住院百分比=2.7%），接受肺动脉监测的可能性降低 1.4 个百分点（95% CI，1.2-1.5；接受肺动脉监测的住院百分比=2.6%），以及接受透析的可能性降低 0.6 个百分点（95% CI，0.4-0.8；接受透析治疗的百分比=4.6%）。结论。在生命的最后 30 天，患有痴呆症的急性护理患者所接受的治疗比没有痴呆症的患者要少得多。需要进一步的研究来确定这些护理模式的原因和适当性。
Objectives. To analyze whether acute care patients with dementia are more or less likely to receive each of five aggressive medical services near the end of life, compared with patients without dementia.Data Source. Two years of Veterans Affairs (VA) and Medicare utilization data for all 169,036 VA users nationwide age 67 and older who died between October 1, 1999 and September 30, 2001.Study Design. We performed a retrospective analysis of acute care stays discharged in the final 30 days of life. The main outcome measure was the patient's likelihood of receiving each of five aggressive services (intensive care unit [ICU] admission, ventilator, cardiac catheterization, pulmonary artery monitor, and dialysis), controlling for demographic and clinical factors in probit regressions.Principal Findings. There were 122,740 acute-stay discharges during the final 30 days of life, representing 94,100 unique patients (31,654 with dementia). In probit models comparing acute care patients with and without dementia, patients with dementia were 7.5 percentage points less likely to be admitted to the ICU (95 percent confidence interval [CI], 6.9-8.1; percent of stays with ICU admission=36.8 percent), 5.4 percentage points less likely to be placed on a ventilator (95 percent CI, 5.0-5.9; percent of stays with ventilator use=17.1 percent), 0.7 percentage points less likely to receive cardiac catheterization (95 percent CI, 0.6-0.8; percent of stays with cardiac catheterization=2.7 percent), 1.4 percentage points less likely to receive pulmonary artery monitoring (95 percent CI, 1.2-1.5; percent of stays with pulmonary artery monitoring=2.6 percent), and 0.6 percentage points less likely to receive dialysis (95 percent CI, 0.4-0.8; percent of stays with dialysis=4.6 percent).Conclusions. During the final 30 days of life, acute care patients with dementia are treated substantially less aggressively than patients without dementia. Further research is warranted to determine the causes and appropriateness of these patterns of care.