急性疾患後の末期認知症における生存率
1Department of Geriatrics, Box 1070, Mount Sinai School of Medicine, One Gustave L. Levy Pl, New York, NY 10029, USA. sean.morrison@mssm.edu
JAMA
|June 29, 2000
まとめ
末期認知症の患者で,股関節骨折や肺炎のために入院した患者は,高い死亡率で,予後が悪い. 介護は,この集団に対する攻撃的な介入よりも,快適さに焦点を当てなければならない.
科学分野:
- ゲリアトリクス ゲリアトリクス
- 緩和ケアとは,緩和ケアです.
- 認知症の研究 認知症の研究
背景:
- 末期認知症の急性疾患患者の予後と介護は,十分に理解されていません.
- 予後が悪い場合,緩和ケアに重点を置くことをお勧めします.
研究 の 目的:
- ヒップ骨折や肺炎で入院した末期認知症患者の生存率を調べる.
- これらの患者が受けたケアを,認知的に健全な高齢者のケアと比較する.
主な方法:
- 6ヶ月のフォローアップ期間を持つ前向きなコホート研究.
- 70歳以上で,股関節骨折や肺炎で入院した患者を含む.
- 認知的に健全な患者と末期認知症患者との比較.
主要な成果:
- 終末期認知症 (53~55%) の患者では,股関節骨折や肺炎の後の認知不全の患者 (12-13%) と比べて,半年死亡率は著しく高かった.
- 終末期認知症の患者は,認知的に健全な患者と同じ数の負担を伴う処置を受けた.
- 終末期認知症の患者は,生命維持治療を放棄する決定を文書化した患者がほとんどなく,鎮痛剤の注文はまれでした.
結論:
- 進行性認知症,股関節骨折,肺炎の患者には,非常に悪い予後が予想されます.
- 平均寿命が短く,治療の負担が大きいことから,この集団の快適さを高めることに重点を置くべきです.
- 緩和ケアアプローチは,治癒的介入よりも推奨されます.
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