生命末期的护理轨迹和过渡:一项基于人群的队列研究。

IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY
Isabelle Dufour, Josiane Courteau, Véronique Legault, Claire Godard-Sebillotte, Pasquale Roberge, Catherine Hudon
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引用次数: 0

摘要

背景:对于 65 岁及以上的老年人来说,生命末期的特点往往是医疗保健使用(HCU)模式不理想,对健康和生活质量造成负面影响。了解这一时期的护理轨迹(CTs)和过渡可以突出潜在的改进领域,但对这一问题的研究还很少:目的:对老年人死亡前两年的护理轨迹(包括护理过渡)进行分类:设计:回顾性队列研究:我们使用了多维状态序列分析和护理轨迹丰富数据(TorSaDE)队列中的数据,该数据是加拿大健康调查和魁北克健康管理数据之间的联系:共有 2080 名死者被分为五个 CT 组。第一组在最后几个月前HCU较低,而第二组在第一年内HCU较低,随后稳步上升。第 3 组和第 4 组的 HCU 在两年内逐渐增加,但第 3 组在最后阶段更为明显。第 2 组和第 4 组的癌症诊断和姑息治疗比例较高,而第 3 组和第 5 组的合并症和痴呆症比例较低。总体而言,68.4%的患者死于医院,27%的患者在医院接受了姑息治疗。临终时,护理过渡迅速增加,尤其是在最后两周:这项研究有助于了解生命最后两年中 CT 的变化情况,包括死亡地点,这是提高质量的关键一步。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Care trajectories and transitions at the end of life: a population-based cohort study.

Background: End-of-life periods are often characterised by suboptimal healthcare use (HCU) patterns in persons aged 65 years and older, with negative effects on health and quality of life. Understanding care trajectories (CTs) and transitions in this period can highlight potential areas of improvement, a subject yet only little studied.

Objective: To propose a typology of CTs, including care transitions, for older individuals in the 2 years preceding death.

Design: Retrospective cohort study.

Methods: We used multidimensional state sequence analysis and data from the Care Trajectories-Enriched Data (TorSaDE) cohort, a linkage between a Canadian health survey and Quebec health administrative data.

Results: In total, 2080 decedents were categorised into five CT groups. Group 1 demonstrated low HCU until the last few months, whilst group 2 showed low HCU over the first year, followed by a steady increase. A gradual increase over the 2 years was observed for groups 3 and 4, though more pronounced towards the end for group 3. A persistent high HCU was observed for group 5. Groups 2 and 4 had higher proportions of cancer diagnoses and palliative care, as opposed to comorbidities and dementia for groups 3 and 5. Overall, 68.4% of individuals died in a hospital, whilst 27% received palliative care there. Care transitions increased rapidly towards the end, most notably in the last 2 weeks.

Conclusion: This study provides an understanding of the variability of CTs in the last two years of life, including place of death, a critical step towards quality improvement.

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来源期刊
Age and ageing
Age and ageing 医学-老年医学
CiteScore
9.20
自引率
6.00%
发文量
796
审稿时长
4-8 weeks
期刊介绍: Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.
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