■在日常习惯中观察到的寿命终止下降的信号,比如进餐时间的参与,对于在长期护理(LTC)居民生命的最后几个月朝着以舒适为中心的护理目标迈进很重要。目前尚不清楚如何将LTC家庭中实时观察到的饮食问题用作可疑生命终结的指标。该研究量化了营养和关键的非营养相关信号(例如,普遍下降,不稳定的生命体征)记录在案,以描述生命终止时间的下降和随后的死亡时间。
■回顾性图表审查确定了第一个有记录的对话,其中医疗团队成员考虑了寿命下降(例如,护士,医师,营养师,家庭成员)来自安大略省西南部9个LTC房屋的76个随机选择的死者,加拿大。计算死亡时间(天)。对可疑的寿命终止下降的自由文本描述进行了定向内容分析,以对信号进行分类。Cox比例风险回归分析检验了与每个分类信号相关的死亡风险。
■居民(平均年龄=88±7岁;60%为女性)的死亡时间为死亡前0天至2年以上(中位数=27.5天)。确定了7个营养相关信号和18个非营养相关信号。吞咽困难(HR=2.99;95%CI=1.41,6.33),认知下降(HR=0.40;95%CI=0.20,0.77),谵妄(HR=13.23;95%CI=1.57,111.69),和癌症(HR=0.18;95%CI=0.07,0.48)与死亡时间相关。
■这项研究提供了对LTC护理提供者使用的信号的见解,以怀疑居民在生命快要结束时正在下降,并确定了与死亡时间相关的四个信号。当被护理提供者确定为寿命终止下降的指标时,吞咽困难和谵妄预测死亡时间较短,而癌症和认知能力下降预示着更长时间的死亡。可以利用对营养和非营养相关信号的识别来系统地引入及时的舒适护理对话。
UNASSIGNED: Signals of end-of-life decline observed in daily habits, such as mealtime participation, are important for moving towards comfort-focused goals of care in the final months of life of long-term care (
LTC) residents. It is unclear how eating issues observed in real-time in
LTC homes are used as indicators of suspected end of life. The study quantifies nutrition and key non-nutrition related signals (eg, general decline, unstable vitals) documented to describe end-of-life decline and the subsequent time to death.
UNASSIGNED: A retrospective chart review identified the first documented conversation where end-of-life decline was considered by members of the care team (eg, nurses, physicians, dietitian, family member) for 76 randomly selected decedents from 9
LTC homes in southwestern Ontario, Canada. Time (days) to death was calculated. A directed content analysis of the free-text description of the suspected end-of-life decline was used to categorize signals. Cox proportional hazards regression analysis tested the risk of mortality associated with each categorized signal.
UNASSIGNED: Time to death of residents (mean age = 88 ± 7 years; 60% female) from the first documentation of potential end-of-life decline ranged from 0 days to over 2 years prior to death (median = 27.5 days). Seven nutrition-related and 18 non-nutrition related signals were identified. Swallowing difficulty (HR = 2.99; 95% CI = 1.41, 6.33), cognitive decline (HR = 0.40; 95% CI = 0.20, 0.77), delirium (HR = 13.23; 95% CI = 1.57, 111.69), and cancer (HR = 0.18; 95% CI = 0.07, 0.48) were associated with time to death.
UNASSIGNED: This study provides insight into the signals used by care providers in
LTC to suspect that residents are declining towards the end of life and identifies four signals that were associated with time to death. When identified by care providers as indicators of end-of-life decline, swallowing difficulty and delirium predicted a shorter time to death, while cancer and cognitive decline predicted a longer time to death. Recognition of nutrition and non-nutrition related signals may be leveraged to systematically introduce timely comfort care conversations.