Caregiver support and place of death among older adults.
Caregiver support and place of death among older adults.
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DOI：
10.1111/jgs.17055
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发表时间：
2021-05
影响因子：
6.3
通讯作者：
Maust DT
中科院分区：
文献类型：
--
作者：
Lei L;Gerlach LB;Powell VD;Maust DT
在美国，家已成为最常见的死亡地点，因此有关照顾者支持和死亡地点的信息对于改善临终患者和照顾者的体验至关重要。我们试图研究（1）家庭照顾可获得性与死亡地点之间的关联；以及（2）与死亡地点相关的照顾强度。
2017年全国健康与老龄化趋势研究以及全国照顾研究；对已故老年人和临终前一个月（LML）照顾者进行的具有全国代表性的横断面研究。
美国；所有死亡地点。
375名死者和267名临终前一个月照顾者。
死亡地点（家中、医院以及养老院或临终关怀机构），家庭照顾可获得性（配偶/伴侣、家庭规模、子女数量），照顾强度（临终前一个月提供帮助的时长以及一个表示与照顾相关的高度情感困难的二元指标）。
38.9%的老年人在家中去世，其次是在医院（33.1%），以及养老院或临终关怀机构（28.0%）。在调整后的多项逻辑回归分析中，家庭规模较大（优势比[OR]：0.441；95%置信区间[CI]：0.269 - 0.724）以及女儿数量较多（OR：0.743[95%CI：0.575 - 0.958]）的死者在养老院或临终关怀机构死亡的几率相对于在家中死亡更低。对于在家中去世的老年人，照顾者在临终前一个月提供了209.8小时的帮助。相比之下，当死亡发生在养老院或临终关怀机构时，根据死者和照顾者的特征进行调整后，照顾者提供的帮助时长减少了91.6小时。与在家中死亡相比，在医院死亡与照顾者出现情感困难的几率更高相关（OR：4.093[95%CI：1.623 - 10.323]）。
家庭规模和女儿数量是死亡地点的重要决定因素。尽管在家中死亡与更多直接照顾时长相关，但医院死亡时照顾者的情感压力更大。为临终照顾者提供更好的支持服务可能会改善在家中及医院死亡的患者和照顾者的体验。
As home becomes the most common place of death in the U.S., information about caregiver support and place of death is critical to improve patient and caregiver experiences at end of life. We seek to examine (1) the association between family care availability and place of death; and (2) caregiving intensity associated with place of death. 2017 National Health and Aging Trends Study and National Study of Caregiving; nationally representative cross-sectional study of deceased older adults and last-month-of-life (LML) caregivers. U.S.; all places of deaths. 375 decedents and 267 LML caregivers. Place of death (home, hospital, and nursing or hospice facility), family care availability (spouse/partner, household size, number of daughters and sons), caregiving intensity (hours of help provided at LML and a binary indicator for high care-related emotional difficulty). 38.9% of older adults died at home, followed by hospital (33.1%), and nursing or hospice facility (28.0%). In an adjusted multinomial logistic regression, decedents with larger household size (odds ratio [OR]: 0.441; 95% confidence interval [CI]: 0.269–0.724) and more daughters (OR: 0.743 [95% CI: 0.575 – 0.958]) had lower odds of dying in nursing or hospice facility relative to dying at home. For older adults who died at home, caregivers provided 209.8 hours of help at LML. In contrast, when death occurred in nursing or hospice facility, caregivers provided 91.6 fewer hours of help, adjusted for decedent and caregiver characteristics. Dying in hospital was associated with higher odds of caregiver emotional difficulty relative to home deaths (OR: 4.093 [95% CI: 1.623–10.323]). Household size and number of daughters are important determinants of place of death. Despite dying at home being associated with more hours of direct caregiving; caregiver emotional strain was experienced as higher for hospital deaths. Better support services for end-of-life caregivers might improve patient and caregiver experiences for home and hospital deaths.
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影响因子：
120.7
作者：
Teno, Joan M.;Gozalo, Pedro L.;Bynum, Julie P. W.;Leland, Natalie E.;Miller, Susan C.;Morden, Nancy E.;Scupp, Thomas;Goodman, David C.;Mor, Vincent
通讯作者：
Mor, Vincent
影响因子：
9.7
作者：
Ornstein, Katherine A.;Kelley, Amy S.;Wolff, Jennifer L.
通讯作者：
Wolff, Jennifer L.
影响因子：
2.8
作者：
Burge, Fred;Lawson, Beverley;Flowerdew, Gordon
通讯作者：
Flowerdew, Gordon
DOI：
10.1111/j.1532-5415.1999.tb01897.x
发表时间：
1999-01-01
影响因子：
6.3
作者：
Fried, TR;Pollack, DM;Tinetti, ME
通讯作者：
Tinetti, ME
影响因子：
3
作者：
Weitzen, S;Teno, JM;Mor, V
通讯作者：
Mor, V