End-of-life experiences among elderly nursing home residents with dementia and issues regarding nursing care

1.本研究的目的是通过阐明老年痴呆症患者在生命末期的进展过程，为制定老年痴呆症患者的生命末期护理计划提供基础数据。2003年至2005年执行了两项调查计划。1调查结果概要从入住新泻县养老院的5名重度痴呆症老年人的病历中获得了从入住时到2005年11月的身体和精神状况数据。一名老人于2003年5月去世。(1)患有严重痴呆的卧床不起的老年人经常发烧，其次是吞咽困难，饮食摄入量减少，喘鸣和意识水平改变。此外，入院时能够行走的老年人在福尔斯跌倒或骨折后进展为卧床不起状态，并遵循类似的过程。(2)比较老年人能够摄食和那些接受输卵管喂养的过程表明，后者有更少的天数， ...更多信息 发热较前，还曾自行拔饲管除肺炎。调查结果概要2从入住千叶县养老院的27名老年痴呆症患者的病例记录中获得了从入住时到2005年8月的体温、饮食摄入量、体重和结果的数据。(1)27名老年人中有11名（40.7%）在3年内死亡。(2)在死亡的老年人中，那些在死亡前一年能够行走的人和那些卧床不起的人在生命结束阶段的进展过程不同。具体而言，前者在死亡前一年内有痴呆症的行为和心理症状，如徘徊和兴奋，并且没有明显的身体体征。总结以上研究结果表明，各种类型的老年痴呆症患者的生命结束的经验存在，并建立适当的护理，为每一个这些类型是必要的。少

1. ObjectiveThe objective of the present study was to obtain basic data for developing an end-of-life care program for elderly with dementia by elucidating the course of progression during the end-of-life stage. Two survey plans were implemented from 2003 to 2005.2. Summary of the results of Survey 1Data regarding physical and mental conditions from the time of admission to November 2005 were obtained from the medical charts of 5 elderly with severe dementia who were admitted to a nursing home in Niigata Prefecture. One elderly died in May 2003.(1) Bedridden elderly with severe dementia had frequent fever, followed by dysphagia, reduced dietary intake, stridor, and altered conscious level. In addition, elderly who were capable of walking at the time of admission progressed to a bedridden state following falls or fractures, and followed a similar course.(2) Comparison of the course of elderly capable of ingestion and those receiving tubal feeding showed that the latter had fewer days of … More fever than the former, but also had self-extubation of the feeding tube in addition to pneumonia.3. Summary of the results of Survey 2Data regarding body temperature, dietary intake, body weight, and outcome from the time of admission to August 2005 were obtained from the case records of 27 elderly with dementia who were admitted to a nursing home in Chiba Prefecture.(1) A total of 11 of 27 (40.7%) elderly died during a 3-year period.(2) Among the elderly who died, those who were capable of walking one year prior to death and those who were bedridden had different courses of progression during the end-of-life stage. Specifically, the former had behavioral and psychological symptoms of dementia such as wandering and excitement during the year preceding death, and exhibited no notable physical signs.4. SummaryThe above findings indicate that various types of end-of-life experiences exist among elderly with dementia, and that establishment of suitable nursing care for each of these types is necessary. Less