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首页> 外文期刊>Journal of Clinical Medicine Research >Predictors of Transition to Hospice Care Among Hospitalized Older Adults With a Diagnosis of Dementia in Texas: A Population-Based Study
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Predictors of Transition to Hospice Care Among Hospitalized Older Adults With a Diagnosis of Dementia in Texas: A Population-Based Study

机译：在德克萨斯州诊断为痴呆的住院老年人中向临终关怀服务过渡的预测因素：一项基于人群的研究

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Background: Decedent older adults with dementia are increasingly less likely to die in a hospital, though escalation of care to a hospital setting, often including critical care, remains common. Although hospice is increasingly reported as the site of death in these patients, the factors associated with transition to hospice care during end-of-life (EOL) hospitalizations of older adults with dementia and the extent of preceding escalation of care to an intensive care unit (ICU) setting among those discharged to hospice have not been examined.Methods: We identified hospitalizations aged ≥ 65 years with a diagnosis of dementia in Texas between 2001 and 2010. Potential factors associated with discharge to hospice were evaluated using multivariate logistic regression modeling, and occurrence of hospice discharge preceded by ICU admission was examined.Results: There were 889,008 elderly hospitalizations with a diagnosis of dementia during study period, with 40,669 (4.6%) discharged to hospice. Discharges to hospice increased from 908 (1.5%) to 7,398 (6.3%) between 2001 and 2010 and involved prior admission to ICU in 45.2% by 2010. Non-dementia comorbidities were generally associated with increased odds of hospice discharge, as were development of organ failure, the number of failing organs, or use of mechanical ventilation. However, discharge to hospice was less likely among non-white minorities (lowest among blacks: adjusted odds ratio (aOR): 0.67; 95% confidence interval (CI): 0.65 - 0.70) and those with non-commercial primary insurance or the uninsured (lowest among those with Medicaid: aOR (95% CI): 0.41 (0.37 - 0.46)).Conclusions: This study identified potentially modifiable factors associated with disparities in transition to hospice care during EOL hospitalizations of older adults with dementia, which persisted across comorbidity and severity of illness measures. The prevalent discharge to hospice involving prior critical care suggests that key discussions about goals-of-care likely took place following further escalation of care to ICU. Together these findings can inform system- and clinician-level interventions to facilitate timely and consistent use of hospice to meet patients’ goals of care.J Clin Med Res. 2017;9(1):23-29doi: https://doi.org/10.14740/jocmr2783w
机译：背景：患有痴呆症的后代老年人在医院死亡的可能性越来越小，尽管将护理升级到医院环境（通常包括重症监护）仍然很普遍。尽管越来越多的报道将临终关怀作为这些患者的死亡地点，但与老年痴呆症成年人在临终（EOL）住院期间过渡到临终关怀护理有关的因素以及先前将护理升级为重症监护病房的程度方法：我们确定了2001年至2010年在德克萨斯州诊断为痴呆的65岁以上住院患者。采用多元逻辑回归模型评估了与临终关怀相关的潜在因素，结果：在研究期间，有889,008例老年痴呆症住院患者被诊断为痴呆，其中40,669例（4.6％）出院。 2001年至2010年间，临终关怀的出院率从908（1.5％）增至7,398（6.3％），到2010年，进入重症监护病房就诊的比例为45.2％。非痴呆合并症通常与临终关怀的发生几率增加有关，器官衰竭，器官衰竭数目或使用机械通气。但是，非白人少数民族（黑人中最低：调整后的优势比（aOR）：0.67; 95％置信区间（CI）：0.65-0.70）和非商业初级保险或未投保的少数民族中，临终关怀的可能性较小。 （在接受医疗补助的人群中最低：aOR（95％CI）：0.41（0.37-0.46））。结论：本研究确定了在老年痴呆症成年人进行EOL住院期间过渡到临终关怀的差异相关的潜在可修正因素，这种情况持续存在合并症和疾病严重程度的衡量标准。涉及先前重症监护的临终关怀医院的普遍出院现象表明，在将护理进一步升级为ICU之后，可能会进行有关护理目标的关键讨论。这些发现共同可以为系统和临床医生提供干预措施，以促进及时，一致地使用临终关怀服务，以满足患者的护理目标。JClin Med Res。 2017; 9（1）：23-29doi：https://doi.org/10.14740/jocmr2783w

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