Advanced Dementia: State of the Art and Priorities for the Next Decade
Advanced Dementia: State of the Art and Priorities for the Next Decade
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DOI：
10.7326/0003-4819-156-1-201201030-00008
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发表时间：
2012-01-03
影响因子：
39.2
通讯作者：
Morrison, R. Sean
中科院分区：
文献类型：
--
作者：
Mitchell, Susan L.;Black, Betty S.;Morrison, R. Sean
在美国，痴呆症是主要的死亡原因。本文概述了目前对晚期痴呆症的理解，并确定了未来十年的研究重点。在过去的25年里，研究主要集中在描述晚期痴呆症患者的经历。这项工作勾勒出了大量的改进机会，包括更多地认识到晚期痴呆症是一种晚期疾病，更好地治疗令人痛苦的症状，更多地获得临终关怀和姑息治疗服务，以及减少使用可能对临床益处有限的昂贵和激进的治疗。处理这些机会必须成为该领域今后十年的首要目标。优先领域包括设计和测试促进高质量、以目标为导向的护理的干预措施；开展卫生政策研究，以确定激励具有成本效益和循证护理的战略；对有希望的干预措施和政策进行执行研究；以及进一步制定针对具体疾病的成果措施。美国有极大的需要和机会来改善结果、控制支出、减少差距，并更好地协调对数百万晚期痴呆症患者的护理。
Dementia is a leading cause of death in the United States. This article outlines the current understanding of advanced dementia and identifies research priorities for the next decade. Research over the past 25 years has largely focused on describing the experience of patients with advanced dementia. This work has delineated abundant opportunities for improvement, including greater recognition of advanced dementia as a terminal illness, better treatment of distressing symptoms, increased access to hospice and palliative care services, and less use of costly and aggressive treatments that may be of limited clinical benefit. Addressing those opportunities must be the overarching objective for the field in the coming decade. Priority areas include designing and testing interventions that promote high-quality, goal-directed care; health policy research to identify strategies that incentivize cost-effective and evidencebased care; implementation studies of promising interventions and policies; and further development of disease-specific outcome measures. There is great need and opportunity to improve outcomes, contain expenditures, reduce disparities, and better coordinate care for the millions of persons in the United States who have advanced dementia.