在生命结束时功能衰退的模式
June R Lunney1, Joanne Lynn, Daniel J Foley
1Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, Md 20892-9205, USA. june_lunney@nih.gov
JAMA
|May 15, 2003
概括
生命末期的功能衰退因疾病轨迹而有很大差异. 脆弱性和器官衰竭显示出最多的下降,而突然死亡显示出最少的,影响护理需求.
科学领域:
- 老年学是指老年学的学科.
- 流行病学 流行病学
- 公共卫生 公共卫生
背景情况:
- 临床医生在终身护理中观察到各种功能衰退模式.
- 关于大群体中这些模式的经验数据有限.
研究的目的:
- 调查四种不同的生命末期疾病轨迹中功能衰退的差异.
- 这些轨迹包括突然死亡,癌症死亡,器官衰竭死亡和虚弱.
主要方法:
- 对老年人流行病学研究 (EPESE) 研究的确立人群的队列分析.
- 在4190名死者死亡前一年内检查的自我或代理报告的身体功能 (日常生活活动 - ADLs).
- 在疾病轨迹中比较ADL依赖,控制人口因素.
主要成果:
- 在四种疾病轨迹中观察到功能衰退的显著差异.
- 突然死亡的死者保持了高功能,而脆弱的死者显示出最多的依赖.
- 癌症和器官衰竭的死者表现出衰退的中间模式,随着死亡的临近,残疾增加.
结论:
- 生命期末的功能衰退轨迹是高度可变的.
- 识别这些独特的模式对于制定量身定制的护理策略和改进生命终端计划至关重要.
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