End-of-life care in special elderly nursing home for very elderly adults in comparison with emergency palliative therapy in general hospitals

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  • 特別養護老人ホームにおける超高齢者の看取りケア‐殊に急性期病院における入院症例との比較について‐
  • 特別養護老人ホームにおける超高齢者の看取りケア--殊に急性期病院における入院症例との比較について
  • トクベツ ヨウゴ ロウジン ホーム ニ オケル チョウコウレイシャ ノ ミトリ ケア コトニ キュウセイキ ビョウイン ニ オケル ニュウイン ショウレイ ト ノ ヒカク ニ ツイテ

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Abstract

Aim: Although the facilities for end-of-life care in the special elderly (SE) nursing home are increasing, there are no standard guidelines for end-of-life care interventions. Furthermore, in the SE nursing home, there are not enough data concerning those who have had end-of-life care and/or emergency hospital palliative therapy. Therefore, we compared the clinical outcome of end-of-life care patients and emergency palliative therapy patients.<br> Participants: Five end-of-life care patients (99±10 years old) in the SE nursing home, and 48 emergency palliative therapy patients (89±15 years old) in the hospitals.<br> Results: All end-of-life care patients are still living after 300±70 days by standard nursing care (mainly fluid diets with small doses of vasodilators and antibiotics) with bed side music. Their average CRP values in terminal end-of-life care patients decreased from 10±12 mg/dl to 1.2±0.5 (p<0.05), serum albumin levels increased from 2.7±1.6 g/dl to 3.5±2.6 and body mass index increased from 16±1.6 to 18.3±0.75 (p<0.05). Among 48 emergency hospitalized palliative patients, 32 patients were discharged to our facility after 120±26 days of hospitalization, whereas 16 patients died in hospital after 100±36 days of hospitalization (aspiration pneumonia: 11 patients, heart failure: 3 patients and G-I causes: 2 patients).<br> Conclusion: End-of-life care in the SE nursing home prolonged their life expectancy despite centenarian status. Hospital mortality rates of palliative emergency therapy were higher than usual end-of-life care. These data suggest that end-of-life care interventions, including bed side music, could provide physical satisfaction.<br>

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