End-of-Life Symptoms in Persons Dying with Advanced Dementia in the Community Setting: Findings from IN-PEACE.

IF 3.2 2区医学 Q2 CLINICAL NEUROLOGY

Journal of pain and symptom management Pub Date : 2025-05-20 DOI:10.1016/j.jpainsymman.2025.05.004

Kurt Kroenke, Sujuan Gao, Susan E Hickman, Alexia M Torke, Nina M Johnson, Amy Pemberton, Andrea Vrobel, Minmin Pan, Laura R Holtz, Greg A Sachs

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Abstract

Context: The symptom burden in persons dying with advanced dementia outside long-term care facilities has not been well studied.

Objectives: To determine the symptom burden in persons dying with advanced dementia in the community setting.

Methods: The sample consisted of patient-caregiver dyads enrolled in the 24-month IN-PEACE trial of home-based care management for advanced dementia. Postmortem interviews were administered to caregivers of persons with advanced dementia who had recently died. The primary outcome was the Comfort Assessment in Dying-End of Life in Dementia (CAD-EOLD) scale. A secondary symptom measure was the Symptom Management in End of Life Dementia (SM-EOLD). Results were analyzed and compared to previous studies using the CAD-EOLD.

Results: Of the 83 persons with dementia who died during 24 months of follow-up, postmortem caregiver interviews were completed in 80 cases of which 79 completed the CAD-EOLD. Patients' mean age was 83.1; 68% were women, 57% white, and 37% African American. Most patients (62%) died at home and only 32% died in a hospital or nursing home. Hospice enrollment occurred in 75% of participants. Symptom management as reflected in CAD-EOLD scores was comparable to previous studies of persons with dementia dying in nursing homes. Compared to baseline SM-EOLD scores, end-of-life symptom scores were 4 points better. Intervention and control group outcomes were similar.

Conclusions: Some community-dwelling persons with advanced dementia can die at home with symptom management comparable to that received in nursing homes.

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社区环境中晚期痴呆患者的临终症状：来自in - peace的研究结果

背景：长期护理机构外晚期痴呆死亡患者的症状负担尚未得到很好的研究。目的：了解社区死亡晚期痴呆患者的症状负担。方法：样本包括参加为期24个月的晚期痴呆家庭护理管理in - peace试验的患者-护理者。对最近死亡的晚期痴呆症患者的护理人员进行了死后访谈。主要终点是痴呆患者临终舒适度评估（CAD-EOLD）量表。第二个症状测量是临终痴呆症状管理（SM-EOLD）。使用CAD-EOLD对结果进行分析并与先前的研究进行比较。结果：在随访24个月期间死亡的83例痴呆患者中，80例完成了死后护理人员访谈，其中79例完成了CAD-EOLD。患者平均年龄83.1岁；68%是女性，57%是白人，37%是非裔美国人。大多数患者（62%）在家中死亡，只有32%在医院或养老院死亡。75%的参与者参加了临终关怀。CAD-EOLD评分所反映的症状管理与之前在养老院死亡的痴呆症患者的研究相当。与基线SM-EOLD评分相比，生命末期症状评分提高4分。干预组与对照组结果相似。结论：一些社区居住的晚期痴呆患者可以在家中死亡，症状管理与在养老院接受的相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of pain and symptom management 医学-临床神经学

CiteScore

8.90

自引率

6.40%

发文量

821

审稿时长

26 days

期刊介绍： The Journal of Pain and Symptom Management is an internationally respected, peer-reviewed journal and serves an interdisciplinary audience of professionals by providing a forum for the publication of the latest clinical research and best practices related to the relief of illness burden among patients afflicted with serious or life-threatening illness.