Factors associated with site of death - A national study of where people die
Factors associated with site of death - A national study of where people die
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DOI：
10.1097/00005650-200302000-00013
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发表时间：
2003-02-01
期刊：
影响因子：
3
通讯作者：
Mor, V
中科院分区：
文献类型：
--
作者：
Weitzen, S;Teno, JM;Mor, V
目标.最近公众的注意力集中在对垂死者的护理质量上。一个人的死亡是一个重要的个人和公共卫生问题。1993年全国死亡率跟踪调查（NMFS）被用来估计发生在家中，医院或养老院的死亡比例。社会人口学变量、潜在死亡原因、地理区域、临终关怀使用、社会支持、健康保险、患者的身体限制和身体衰退被认为是死亡部位的可能预测因素。用多项逻辑回归分析这些预测因子与研究中心死亡的关系。近60%的死亡发生在医院，约20%的死亡发生在家中或疗养院。死者，谁是黑人，教育程度较低，并参加了HMO更有可能死在医院。校正后，生命最后5个月内的功能下降是在家死亡的重要预测因素（丧失3个或更多ADL [OR，1.57; 95% CI，1.11-2.21]）。死亡前1年有功能受限，以及在生命的最后5个月经历功能下降都与在疗养院死亡有关。在过去的5个月里，快速的身体衰退与在家中或养老院死亡有关，而早期的功能丧失与在养老院死亡有关。
OBJECTIVES. Recent public attention has focused on quality of care for the dying. Where one dies is an important individual and public health concern.MATERIALS AND METHODS. The 1993 National Mortality Followback Survey (NMFS) was used to estimate the proportion of deaths occurring at home, in a hospital, or in a nursing home. Sociodemographic variables, underlying cause of death, geographic region, hospice use, social support, health insurance, patients' physical limitations, and physical decline were considered as possible predictors of site of death. The relationship between these predictors and site death with multinomial logistic regression methods was analyzed.RESULTS. Nearly 60% of deaths occurred in hospitals, and approximately 20% of deaths took place at home or in nursing homes. Decedents, who were black, less educated, and enrolled in an HMO were more likely to die in the hospital. After adjustment, functional decline in the last 5 months of life was an important predictor of dying at home (for loss of 3 or more ADLs [OR, 1.57; 95% Cl, 1.11-2.21]). Having functional limitations 1 year before death, and experiencing functional decline in the last 5 months of life were both associated with dying in a nursing home.CONCLUSIONS. Rapid physical decline during the last 5 months was associated with dying at home or in a nursing home, whereas earlier functional loss was associated with dying in a nursing home.