O-38: Uncomfortable signs and symptoms of the last 6-month life of institutional residents with advanced dementia

摘要

Introduction: Patients in the final stage of dementia usually have recurrent complications that may even be life-threatening, requiring emergency room visits or hospitalizations. The purpose of this study is to explore the uncomfortable symptoms of the last 6-month life with advanced dementia residents. Method: A prospective cohort study of 320 advanced dementia residents who had reached Functional Assessment Staging Score (FAST score) stage Seven C or greater in 32 long-term care facility of northern, central, and southern Taiwan from December 15, 2015, until May 15, 2017. With follow-up prospectively for 6-month or death during the follow-up, and data collection were included demographic characteristics, health and medical status, and death recording information. Result: During the follow-up period, a total of 70 residents died. The major cause of death by multiple organ failure related to pneumonia. With 77.1% of residents who died in hospital. The mean age of residents was 86.2 years; 52.9% were female. The mean length of facility stay was 4.4 years. The mean duration of dementia was 7.4 years. The proportion of residents who had common uncomfortable signs and symptoms of last six-month included: (1) Respiratory system: 68.6% had a short of breathing, and oxygen dependency (> 20 days/month), 30% had use of non-invasive positive pressure ventilation permanently; (2) gastrointestinal (GI) system and nutrition status: upper gastrointestinal bleeding, 47.1%; GI dysfunction (include abdominal distention, nausea, vomiting), 95.7%; decreased intake of nutrients over 25%, 14.3%, malnutrition (Albumin level < 2.5 g/dl or weight loss >10%), 35.7%; severe pressure injuries (C stage III), 24.3%; (3) Acute medical conditions: emer gency visits, 5.7%; hospitalized, 94.3%; days of hospitalized, 35.2 ± 27.6; diagnosis of cardio-cerebrovascular diseases, 8.6% treating electrolyte abnormalities, 78.6%; pneumonia, 88.6%; UTI, 74.3%; receive antimicrobial therapy, 97.1%; days of antimicrobia use, 58.6 ± 31.1; use of life-sustaining treatment, 35.7%. Conclusion: Our study revealed that residents usually have recurren complications (e.g., respiratory distress, infections, skin problems, nutrition problems) that be life-threatening and receive many aggres sive treatments. The findings of this study can provide the basis to develop on-the-job training programs for hospice/palliative care nurs ing education in long-term care institutions. To provide better care, it is recommended that an inventory regarding decision-making of life supporting treatment for clinical and research use be constructed.