Characteristics and End-of-Life Care Pathways of Decedents From a National Cohort of Assisted Living Residents.
Characteristics and End-of-Life Care Pathways of Decedents From a National Cohort of Assisted Living Residents.
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全国辅助生活居民队列死者的特征和临终关怀途径。
DOI：
10.1097/mlr.0000000000001959
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发表时间：
2024
期刊：
影响因子：
3
通讯作者：
Thomas,KaliS
中科院分区：
文献类型：
--
作者：
Belanger,Emmanuelle;Rosendaal,Nicole;Wang,XiaoJoyce;Teno,JoanM;Gozalo,PedroL;Dosa,David;Thomas,KaliS
背景：辅助生活(AL)是一种越来越常见的临终关怀场所。然而，尚不清楚居民在多大程度上能够就地老龄化，或者AL是否代表着生前的额外过渡。目标：检查AL居民生前的社会人口学特征、合并症、卫生保健利用和临终关怀途径。研究设计：利用行政索赔数据，对2017年1月居住在大型AL社区(25张以上床位)的按服务付费的医疗保险受益人进行全国性队列研究。研究对象：268,812名AL居民。测量：社会人口学特征，共生情况，以及临终时的卫生保健利用。结果：2017至2019年，研究队列中有35.1%的人死亡。死者比整个AL人群更有可能超过85岁(76.5%比59.5%)，并被诊断为阿尔茨海默病和相关痴呆症(70.3%比51.6%)。大多数死者(96.2%)在生命的最后一年曾在AL中出现过，但超过五分之一的人在生命的最后一个月前离开了AL。在死前30天的AL患者中，近一半(46.4%)的患者死于原地，没有任何医疗过渡，而13.2%的患者死前有3次或3次以上的转移。结论：AL是临终患者，尤其是痴呆症患者的重要护理场所。这些发现表明，有必要评估指导照顾濒临死亡的AL居民的虚弱和脆弱人口的现有政策和程序。
Background:Assisted living (AL) is an increasingly common, place of care for dying persons. However, it remains unclear to what extent residents are able to age in place or if AL represents an additional transition before death.Objectives:Examine the sociodemographic characteristics, comorbidities, health care utilization, and end-of-life care pathways of AL residents before death.Research Design:A national cohort study of fee-for-service Medicare beneficiaries residing in large AL communities (25+ beds) during the month of January 2017 with 3 years of follow-up, using administrative claims data.Subjects:268,812 AL residents.Measures:Sociodemographic characteristics, comorbidities, and health care utilization at the end of life.Results:Between 2017 and 2019, 35.1% of the study cohort died. Decedents were more likely than the overall AL population to be 85 years old or older (76.5% vs. 59.5%), and diagnosed with Alzheimer’s disease and related dementia (70.3% vs. 51.6%). Most decedents (96.2%) had some presence in AL during the last year of life, but over 1 in 5 left AL before the last month of life. Among those in AL on day 30 before death, nearly half (46.4%) died in place without any health care transition, while 13.2% had 3 or more transfers before dying.Conclusions:AL is an important place of care for dying persons, especially for those with dementia. These findings indicate a need to assess existing policies and processes guiding the care of the frail and vulnerable population of dying AL residents.