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

1.目的本研究的目的是通过阐明老年痴呆患者临终阶段的发展过程，为制定老年痴呆临终关怀计划提供基础数据。2003年至2005.2年间实施了两项调查计划。1调查结果摘要从新泻县一家养老院收治的5名重度痴呆症老人的病历中获取入院至2005年11月的身心健康状况数据。2003年5月死亡1例。(1)卧床不起的重度痴呆患者经常发热，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跌倒或骨折后进展到卧床状态，并遵循类似的过程。(2)能够进食的老年人和接受输卵管喂养的老年人的病程比较显示，后者的…天数较少较前者发热较多，除肺炎外，还出现了自行拔管的喂养管。2调查结果摘要从千叶县养老院收治的27例老年痴呆症患者的病历中获取入院至2005年8月的体温、膳食摄入量、体重和结局的数据。(1)27名老年人中有11名(40.7%)在3年期间死亡。(2)在死亡的老年人中，死亡前一年能够行走的老年人和卧床不起的老年人在临终阶段的进展过程不同。具体地说，前者在去世前一年内有游荡、兴奋等痴呆的行为和心理症状，没有表现出明显的生理症状。以上研究结果表明，老年痴呆症患者存在不同类型的临终经历，有必要为每种类型建立适当的护理。较少

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