Occurrence and treatment of suspected pneumonia in long-term care residents dying with advanced dementia.
Occurrence and treatment of suspected pneumonia in long-term care residents dying with advanced dementia.
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死于晚期痴呆的长期护理居民中疑似肺炎的发生和治疗。
DOI：
10.1111/j.1532-5415.2005.00524.x
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发表时间：
2006
影响因子：
6.3
通讯作者：
Mitchell,SusanL
中科院分区：
文献类型：
--
作者：
Chen,Jen-Hau;Lamberg,JenniferL;Chen,Yen-Ching;Kiely,DanK;Page,JohnH;Person,CarmelJ;Mitchell,SusanL
目的：描述终末期痴呆患者疑似肺炎的发生和管理，并确定与抗生素治疗积极性相关的因素。设计：回顾性队列研究。设置：马萨诸塞州波士顿的一家675张床位的长期护理机构。参与者：240名65岁及以上的受试者，在2001年1月至2003年12月期间死于晚期痴呆。受试者在过去6个月的生活中有疑似肺炎determined.Measurements：自变量包括受试者的特征和疑似肺炎发作的特点。这些变量来自医疗记录。确定每次发作的抗生素治疗。多变量分析用于确定与治疗积极性相关的自变量。结果：154例（64%）晚期痴呆患者在生命的最后6个月内经历了229次疑似肺炎发作。在死亡后30天内，53%的受试者出现疑似肺炎。229次发作的抗生素治疗情况如下：无，9%;仅口服，37%;肌肉注射，25%;静脉注射，29%。与更具侵入性治疗独立相关的因素是缺乏不住院令（校正比值比（AOR）=3.24，95%置信区间（CI）=2.02-5.22），抽吸（AOR=2.75，95% CI=1.44-5.26），主要语言非英语（AOR=2.21，95% CI=1.17-4.15），生命体征不稳定（AOR=2.02，95% CI=1.10-3.72）。结论：肺炎是晚期痴呆患者常见的终末事件，许多患者接受肠外抗生素治疗。治疗的积极性主要取决于预先的护理计划、患者的文化背景和疑似肺炎发作的临床特征。
Objectives:To describe the occurrence and management of suspected pneumonia in end‐stage dementia and to identify factors associated with aggressiveness of antibiotic treatment.Design:Retrospective cohort study.Setting:A 675‐bed long‐term‐care facility in Boston, Massachusetts.Participants:Two hundred forty subjects aged 65 and older who died with advanced dementia between January 2001 and December 2003. Subjects who had suspected pneumonia during the last 6 months of life were identified.Measurements:Independent variables included subject characteristics and features of suspected pneumonia episodes. These variables were obtained from medical records. Antibiotic treatment for each episode was determined. Multivariate analysis was used to identify independent variables associated with aggressiveness of treatment.Results:One hundred fifty‐four (64%) subjects with advanced dementia experienced 229 suspected pneumonia episodes during the last 6 months of life. Within 30 days of death, 53% of subjects had suspected pneumonia. Antibiotic treatment for the 229 episodes was as follows: none, 9%; oral only, 37%; intramuscular, 25%; and intravenous, 29%. Factors independently associated with more‐invasive therapy were lack of a do‐not‐hospitalize order (adjusted odds ratio (AOR)=3.24, 95% confidence interval (CI)=2.02–5.22), aspiration (AOR=2.75, 95% CI=1.44–5.26), primary language not English (AOR=2.21, 95% CI=1.17–4.15), and unstable vital signs (AOR=2.02, 95% CI=1.10–3.72).Conclusion:Pneumonia is a common terminal event in advanced dementia for which many patients receive parenteral antibiotics. The aggressiveness of treatment is most strongly determined by advance care planning, the patient's cultural background, and clinical features of the suspected pneumonia episode.