The Clinical Course of Advanced Dementia

被引：1126

作者：

Mitchell, Susan L. ^{[1
,2
]}

Teno, Joan M. ^{[4
]}

Kiely, Dan K. ^{[1
]}

Shaffer, Michele L. ^{[5
]}

Jones, Richard N. ^{[1
,2
]}

Prigerson, Holly G. ^{[3
]}

Volicer, Ladislav ^{[6
]}

Givens, Jane L. ^{[1
,2
]}

Hamel, Mary Beth ^{[2
]}

机构：

[1] Hebrew SeniorLife Inst Aging Res, Boston, MA USA

[2] Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA

[3] Dana Farber Canc Inst, Ctr Psychosocial Oncol & Palliat Care Res, Boston, MA 02115 USA

[4] Brown Univ, Ctr Gerontol & Hlth Care Res, Dept Community Hlth, Alpert Med Sch, Providence, RI 02912 USA

[5] Penn State Coll Med, Hershey, PA USA

[6] Univ S Florida, Sch Aging Studies, Tampa, FL USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2009年 / 361卷 / 16期

关键词：

NURSING-HOME RESIDENTS; LONG-TERM-CARE; ADVANCED ALZHEIMERS-DISEASE; MANAGEMENT; HOSPICE; PAIN; PATTERNS; SURVIVAL; FAILURE; HEALTH;

D O I：

10.1056/NEJMoa0902234

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Dementia is a leading cause of death in the United States but is underrecognized as a terminal illness. The clinical course of nursing home residents with advanced dementia has not been well described. METHODS We followed 323 nursing home residents with advanced dementia and their health care proxies for 18 months in 22 nursing homes. Data were collected to characterize the residents' survival, clinical complications, symptoms, and treatments and to determine the proxies' understanding of the residents' prognosis and the clinical complications expected in patients with advanced dementia. CONCLUSIONS Pneumonia, febrile episodes, and eating problems are frequent complications in patients with advanced dementia, and these complications are associated with high 6-month mortality rates. Distressing symptoms and burdensome interventions are also common among such patients. Patients with health care proxies who have an understanding of the prognosis and clinical course are likely to receive less aggressive care near the end of life.

引用

页码：1529 / 1538

页数：10

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