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背景随着老年人数量的增加,临终关怀的居住地点和照护地点也变得越来越重要。目的比较荷兰住家与居住照护之家老年人临终关怀情况。方法选取非突发死亡的年龄≥65岁的老年人(n=498),记录研究对象死亡前1年的主要居住地点(住家或居住照护之家)。采用χ2检验、曼-惠特尼U检验和多元Logistic回归分析,对差异进行分析。结果对住家和居住照护之家老年人数差异进行控制后,在治疗目标、临终关怀交流、专门临终关怀方案使用方面未发现差异。然而,居住照护之家老年人与住家老年人比较,更易得到全科医生的临终关怀〔OR=2.84,95%CI(1.41,5.07)〕。在死亡前3个月内,居住照护之家老年人在医疗机构之间的转诊率低〔OR=2.76,95%CI(1.35,5.63)〕、住院率低〔OR=2.2,95%CI(1.04,4.67)〕、医院中死亡率低〔OR=0.78,95%CI(0.63,0.97)〕。结论尽管治疗目标相似,居住照护之家老年人在临终前转诊率和住院率更低。然而,老年人更倾向于住家,故应采取措施减少转诊率和住院率。
Background As the number of older persons increases, the place of hospice residence and the place of care are also becoming more and more important. Objectives To compare the hospice care of the elderly in homes and residential care homes in the Netherlands. Methods Elderly persons aged 65 years or older without sudden death (n = 498) were selected and their main place of residence (home or residential care home) was recorded one year prior to the death of the study subjects. The χ2 test, Mann-Whitney U test and multivariate Logistic regression analysis were used to analyze the differences. Results After controlling for differences in the number of elderly people in residential and residential care homes, no differences were found in the use of treatment goals, hospice care, and specialized hospice programs. However, elderly living in nursing homes were more likely to receive hospice (OR = 2.84, 95% CI (1.41, 5.07)) than their elderly counterparts. In the three months before death, the elderly people living in nursing homes had a lower referral rate among medical institutions (OR = 2.76, 95% CI (1.35, 5.63)] and a lower rate of hospitalization (OR = 2.2, 95% CI (1.04, 4.67)], and hospital mortality was low [OR = 0.78, 95% CI (0.63, 0.97)]. Conclusion Despite the similar treatment goals, the elderly referral rate and hospitalization rate in domiciliary care homes are lower at the time of dying. However, older people are more likely to live in homes and should therefore take steps to reduce the referral and hospitalization rates.