Satisfaction with end-of-life care for nursing home residents with advanced dementia

被引:111
作者
Engel, Sharon E.
Kiely, Dan K.
Mitchell, Susan L.
机构
[1] Emory Univ, Sch Med, Atlanta, GA 30306 USA
[2] Inst Aging Res, Boston, MA USA
关键词
dementia; palliative care; nursing home;
D O I
10.1111/j.1532-5415.2006.00900.x
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
OBJECTIVES: To identify factors associated with satisfaction with care for healthcare proxies (HCPs) of nursing home (NH) residents with advanced dementia. DESIGN: Cross-sectional study. SETTING: Thirteen NHs in Boston. PARTICIPANTS: One hundred forty-eight NH residents aged 65 and older with advanced dementia and their formally designated HCPs. MASUREMENTS: The dependent variable was HCPs' score on the Satisfaction With Care at the End of Life in Dementia (SWC-EOLD) scale (range 10-40; higher scores indicate greater satisfaction). Resident characteristics analyzed as independent variables were demographic information, functional and cognitive status, comfort, tube feeding, and advance care planning. HCP characteristics were demographic information, health status, mood, advance care planning, and communication. Multivariate stepwise linear regression was used to identify factors independently associated with higher SWC-EOLD score. RESULTS: The mean ages +/- standard deviation of the 148 residents and HCPs were 85.0 +/- 8.1 and 59.1 +/- 11.7, respectively. The mean SWC-EOLD score was 31.0 +/- 4.2. After multivariate adjustment, variables independently associated with greater satisfaction were more than 15 minutes discussing advance directives with a care provider at the time of NH admission (parameter estimate = 2.39, 95% confidence interval (CI) = 1.16-3.61, P < .001), greater resident comfort (parameter estimate = 0.10, 95% CI = 0.020.17, P = .01), care in a specialized dementia unit (parameter estimate = 1.48, 95 % CI = 0.25-2.71, P = .02), and no feeding tube (parameter estimate = 2.87, 95% CI = 0.46-5.25, P = .02). CONCLUSION: Better communication, greater resident comfort, no tube feeding, and care in a specialized dementia unit are modifiable factors that may improve satisfaction with care in advanced dementia.
引用
收藏
页码:1567 / 1572
页数:6
相关论文
共 29 条
[1]   THE TEST FOR SEVERE IMPAIRMENT - AN INSTRUMENT FOR THE ASSESSMENT OF PATIENTS WITH SEVERE COGNITIVE DYSFUNCTION [J].
ALBERT, M ;
COHEN, C .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 1992, 40 (05) :449-453
[2]   Differences in supporting families of dementia patients and cancer patients: a palliative perspective [J].
Albinsson, L ;
Strang, P .
PALLIATIVE MEDICINE, 2003, 17 (04) :359-367
[3]   Tube feeding in patients with advanced dementia - A review of the evidence [J].
Finucane, TE ;
Christmas, C ;
Travis, K .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1999, 282 (14) :1365-1370
[4]   Sounding board - Rethinking the role of tube feeding in patients with advanced dementia [J].
Gillick, MR .
NEW ENGLAND JOURNAL OF MEDICINE, 2000, 342 (03) :206-210
[5]   Alzheimer disease in the US population - Prevalence estimates using the 2000 census [J].
Hebert, LE ;
Scherr, PA ;
Bienias, JL ;
Bennett, DA ;
Evans, DA .
ARCHIVES OF NEUROLOGY, 2003, 60 (08) :1119-1122
[6]   Short screening scales to monitor population prevalences and trends in non-specific psychological distress [J].
Kessler, RC ;
Andrews, G ;
Colpe, LJ ;
Hiripi, E ;
Mroczek, DK ;
Normand, SLT ;
Walters, EE ;
Zaslavsky, AM .
PSYCHOLOGICAL MEDICINE, 2002, 32 (06) :959-976
[7]   Evaluating end-of-life care from the perspective of the patient's family [J].
Larson, JS ;
Larson, KK .
EVALUATION & THE HEALTH PROFESSIONS, 2002, 25 (02) :143-151
[8]  
LUCHINS DJ, 1993, J AM GERIATR SOC, V41, P25
[9]   The interplay of work and caregiving: Relationships between role satisfaction, role involvement, and caregivers' well-being [J].
Martire, LM ;
Stephens, MAP ;
Atienza, AA .
JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES, 1997, 52 (05) :S279-S289
[10]   Dying with advanced dementia in the nursing home [J].
Mitchell, SL ;
Kiely, DK ;
Hamel, MB .
ARCHIVES OF INTERNAL MEDICINE, 2004, 164 (03) :321-326