高齢者の死亡に関する快適性の向上:クラスターランダム化制御試験
Kim Beernaert1, Tinne Smets1, Joachim Cohen1
1End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium; End-of-Life Care Research Group, Ghent University, Ghent, Belgium.
Lancet (London, England)
|May 21, 2017
まとめ
生命の最後の日におけるケアプログラム (CAREFuL) は,急性老年病棟の高齢者の看護師による快適さを向上させました. 継続的なモニタリングが必要ですが,CAREFuLは終末期医療の質を向上させる可能性を示しています.
科学分野:
- 高齢者医療
- 緩和ケア
- 臨床試験
背景:
- 急性疾患の病院での死亡率は高く,しばしば終末期のケアが不十分である.
- 高齢者の50%以上が病院で死亡し,死の段階で医療の質を向上させる必要がある.
研究 の 目的:
- 人生の終わりに近づいている高齢者の快適さとケア品質を向上させるための"最後の日のケアプログラム (CAREFuL) "の有効性を評価する.
- 急性高齢者ケアにおける快適さと症状管理に対するCAREFuLの影響を評価する.
主な方法:
- クラスターによるランダム化対照試験で,ベルギーのフランドリー地域にある10の病院が参加した.
- 5つの病院でCAREFuL (ケアガイド,トレーニング,ドキュメント) を実施し,他の5つの病院で標準的なケアを実施しました.
- 主要アウトカム:看護師と家族の介護者によって評価された快適さ (CAD-EOLD) と症状管理 (SM-EOLD).
主要な成果:
- CAREFuLは,標準治療と比較して,看護師による快適性 (CAD- EOLD) を著しく改善した (p< 0. 0001).
- 家族の介護者によって評価された快適さや,看護師や家族の介護者によって評価された症状管理 (SM- EOLD) では,有意な差異は認められなかった.
- この研究では451人の患者で,CAREFuL群の132人,対照群の109人を対象に評価を行った.
結論:
- CAREFuLプログラムの実施は,急性老年病棟の患者の終末期ケアを強化する可能性があります.
- CAREFuLプログラムの効果をさらに検証するために,継続的なモニタリングが推奨されます.
- 看護師によって評価された快適さは改善されたが,症状管理と家族によって報告された結果を最適化するためにさらなる研究が必要になる可能性がある.
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