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首页> 外文期刊>BMC Geriatrics >Dying comfortably in very old age with or without dementia in different care settings – a representative “older old” population study
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Dying comfortably in very old age with or without dementia in different care settings – a representative “older old” population study

机译：在具有不同照护环境的老年痴呆症患者中舒适地死亡-一项代表性的“老年”人群研究

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Background Comfort is frequently ranked important for a good death. Although rising numbers of people are dying in very old age, many with dementia, little is known about symptom control for “older old” people or whether care in different settings enables them to die comfortably. This study aims to examine, in a population-representative sample, associations between factors potentially related to reported comfort during very old people’s final illness: physical and cognitive disability, place of care and transitions in their final illness, and place of death. Methods Retrospective analyses linked three data sources for n =?180 deceased study participants (68% women) aged 79–107 in a representative population-based UK study, the Cambridge City over-75s Cohort (CC75C): i) prospective in-vivo dementia diagnoses and cognitive assessments, ii) certified place of death records, iii) data from interviews with relatives/close carers including symptoms and “How comfortable was he/she in his/her final illness?” Results In the last year of life 83% were disabled in basic activities, 37% had moderate/severe dementia and 45% minimal/mild dementia or cognitive impairment. Regardless of dementia/cognitive status, three-quarters died following a final illness lasting a week or longer. 37%, 44%, 13% and 7% of the deceased were described as having been “very comfortable”, “comfortable”, “fairly comfortable” or “uncomfortable” respectively during their final illness, but reported symptoms were common: distress, pain, depression and delirium or confusion each affected 40–50%. For only 10% were no symptoms reported. There were ≥4-fold increased odds of dying comfortably associated with being in a care home during the final illness, dying in a care home, and with staying in place (dying at what death certificates record as “usual address”), whether home or care home, compared with hospital, but no significant association with disability or dementia/cognitive status, regardless of adjustment. Conclusions These findings are consistent with reports that care homes can provide care akin to hospice for the very old and support an approach of supporting residents to stay in their care home or own home if possible. Findings on reported high prevalence of multiple symptoms can inform policy and training to improve older old people’s end-of-life care in all settings.
机译：背景舒适度通常被认为对良好的死亡至关重要。尽管越来越多的人在非常老的年龄中死去，其中许多人患有痴呆症，但对于“老年人”的症状控制或在不同环境中的护理是否使他们舒适地死去的知之甚少。这项研究的目的是在具有代表性的样本中，研究与老年人最终患病期间所报告的舒适度可能相关的因素之间的关联：身体和认知障碍，照护地点和他们的最终疾病过渡以及死亡地点。方法回顾性分析将一项基于人群的代表性英国研究（剑桥市75岁以上人群（CC75C））中n =？180死于研究的参与者（79-107岁，女性占68％）的三个数据源进行了关联：i）前瞻性体内痴呆症的诊断和认知评估，ii）认证的死亡地点记录，iii）亲戚/密友的访谈数据，包括症状和“他/她的最终疾病状况如何？”结果在生命的最后一年中，有83％的人基本活动失能，37％的人患有中度/重度痴呆，45％的轻度/轻度痴呆或认知障碍。不论痴呆/认知状态如何，四分之三的人死于持续一周或更长时间的最终疾病。死者中有37％，44％，13％和7％被描述为在他们最后生病期间分别“非常舒适”，“舒适”，“相当舒适”或“不舒适”，但据报道症状很常见：遇险，疼痛，抑郁，del妄或精神混乱各有40％至50％。仅10％的患者没有症状报告。不论是否在家，死于在最终疾病期间在疗养院，在疗养院死亡和留在原处（死于死亡证明记录为“通常的住所”）的几率增加≥4倍或护理院，与医院相比，但与残疾或痴呆/认知状态无显着相关性，无论是否进行调整。结论这些发现与养老院可以为非常老的老人提供临终关怀的报告相一致，并支持了一种在可能的情况下支持居民留在养老院或自己家中的方法。报告的多种症状高发的发现可以为政策和培训提供信息，以改善老年人在所有情况下的临终护理。

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