Advance Care Planning in Nursing Homes and Assisted Living Communities
Advance Care Planning in Nursing Homes and Assisted Living Communities
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DOI：
10.1016/j.jamda.2008.10.015
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发表时间：
2009-05-01
影响因子：
7.6
通讯作者：
Zimmerman, Sheryl
中科院分区：
文献类型：
--
作者：
Daaleman, Timothy P.;Williams, Christianna S.;Zimmerman, Sheryl
目的：确定长期护理 (LTC) 机构中死亡人员的预先护理计划 (ACP) 的流行率和特征，并检查受访者、机构、死者和家庭特征与 ACP 之间的关系。设计：对死者家属和死者接受护理的机构联络人进行死后访谈。背景：对佛罗里达州、马里兰州、新泽西州和北部地区 164 个寄宿护理/辅助生活机构和疗养院进行分层抽样Carolina.受试者：家庭成员和设施联络员分别针对 1015 名已故居民提供了 446 份和 1014 份报告。测量：死亡/临终讨论的报告、已知的治疗偏好以及签署的生前遗嘱 (LW)、医疗保健授权书 (HCPOA)、不复苏命令和不住院命令的报告和记录。测量：死亡/临终讨论的报告、已知的治疗偏好以及签署的生前遗嘱 (LW)、医疗保健授权书 (HCPOA)、不复苏命令和不住院命令的报告和记录。结果：与机构报告相比，家庭受访者报告的 HCPOA（92% 比 49%）和 LW（84% 比 43%）患病率更高。在家庭报告中，非白人种族和没有私人保险与 LW 和 HCPOA 患病率较低显着相关；此外，居住在疗养院（相对于辅助生活设施）和北卡罗来纳州与报告的 LW 患病率较低有关。在机构报告中，非白人种族、意外死亡和居住在北卡罗来纳州或马里兰州与 LW 患病率较低显着相关，而医疗补助病例组合较多、认知状态完整和家庭参与度较高与 HCPOA 患病率较低相关。在床位少于 120 个的机构中，家庭和机构报告 HCPOA 的一致性显着更高。结论：LTC 中 ACP 的患病率比之前描述的要高得多，并且当机构或家庭护理人员报告时，尽管一致性较高，但与 ACP 相关的特征存在显着差异。 (J Am Med Dir Assoc 2009；10：243-251)
Objectives: To determine the prevalence and characteristics of advance care planning (ACP) among persons dying in long-term care (LTC) facilities, and to examine the relationship between respondent, facility, decedent, and family characteristics and ACP.Design: After-death interviews of family members of decedents and facility liaisons where decedents received care.Setting: Stratified sample of 164 residential care/assisted living facilities and nursing homes in Florida, Maryland, New Jersey, and North Carolina.Subjects: Family members and facility liaisons who gave 446 and 1014 reports, respectively, on 1015 decedent residents. Measurements: Reports of death/dying discussions, known treatment preferences, and reports and records of signed living wills (LW), health care powers of attorney (HCPOA), do-not-resuscitate orders, and do-not-hospitalize orders.Measurements: Reports of death/dying discussions, known treatment preferences, and reports and records of signed living wills (LW), health care powers of attorney (HCPOA), do-not-resuscitate orders, and do-not-hospitalize orders.Results: Family respondents reported a higher prevalence, compared with facility reports, of HCPOAs (92% versus 49%) and LWs (84% versus 43%). In family reports, non-white race and no private insurance were significantly associated with lower prevalence of LWs and HCPOAs; additionally, residing in nursing homes (versus assisted living facilities) and in North Carolina were associated with lower prevalence of reported LWs. In facility reports, non-white race, unexpected death, and residing in North Carolina or Maryland were significantly associated with lower prevalence of LWs, whereas high Medicaid case mix, intact cognitive status, and high family involvement were associated with lower prevalence of HCPOAs. Concordance of family and facility reporting of HCPOAs was significantly greater in facilities with fewer than 120 beds.Conclusions: The prevalence of ACP in LTC is much higher than previously described, and there is marked variation in characteristics associated with ACP, despite moderately high concordance, when reported by the facility or family caregivers. (J Am Med Dir Assoc 2009; 10: 243-251)