Older persons' preferences for site of terminal care
Older persons' preferences for site of terminal care
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DOI：
10.7326/0003-4819-131-2-199907200-00006
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发表时间：
1999-07-20
影响因子：
39.2
通讯作者：
Drickamer, MA
中科院分区：
文献类型：
--
作者：
Fried, TR;van Doorn, C;Drickamer, MA
工作背景：目的：描述老年人对家庭或医院作为临终关怀场所的偏好，并探讨其偏好的潜在原因。设计：横断面定量和定性访谈。设置：参与者的家中。患者：最近因充血性心力衰竭、慢性阻塞性肺病住院的65岁或以上社区居民，246例患者参加了定量访谈，29例患者参加了定性访谈。测量：对临终关怀地点的偏好及其原因。结果：在定量访谈中，118名患者（48%）更喜欢在医院接受临终关怀，106名（43%）更喜欢在家，22名（9%）不知道。三分之一的人在被问及他们对非绝症的偏好时改变了他们的偏好。定性访谈中确定的偏好原因包括希望与家庭成员在一起，担心家庭成员的负担及其提供必要护理的能力。长期护理需求的关注，导致在选择时，不受限制的家庭和hospital.Conclusions：优先为家的照顾绝症的网站超过现有的做法。然而，目前关于家庭与医院作为临终关怀的理想场所的争论可能忽略了老年人的一个重要问题，即死亡前的残疾护理。
Background: Little is known about patients' preferences for site of terminal care,Objective: To describe older persons' preferences for home or hospital as the site of terminal care and to explore potential reasons for their preferences.Design: Cross-sectional quantitative and qualitative interviews.Setting: Participants' homes.Patients: Community-dwelling persons 65 years of age or older who were recently hospitalized with congestive heart failure, chronic obstructive pulmonary disease, or pneumonia and were not selected according to life expectancy; 246 patients participated in quantitative interviews and 29 participated in qualitative interviews.Measurements: Preference for site of terminal care and the reasons for that preference.Results: In quantitative interviews, 118 patients (48%) preferred terminal care in the hospital, 106 (43%) preferred home, and 22 (9%) did not know. One third changed their preference when asked about their preference in the event of a nonterminal illness. Reasons for preference identified during qualitative interviews included the desire to be with family members and concerns about burden to family members and their ability to provide necessary care. Concern about long-term care needs resulted in preference for a nursing home when choice was not constrained to home and hospital.Conclusions: Preference for home as the site of care for terminal illness exceeds existing practice. However, the current debate about home versus hospital as the ideal site for end-of-life care may ignore an important issue to older persons-namely, the care of disabilities that precede death.