- 期刊
Place of Death in Centenarians in Taiwan and the Need for Home Hospice Care
從台灣百歲人瑞的死亡地點談居家安寧療護之需求
摘要
Taiwan represents one of the fastest aging countries in the world. Facing the end of life, the centenarians experience different causes of death as compared with younger elders. Usually, the centenarians' preference for place of death is outside the hospital in a homely environment. No study has ever considered the effects of hospice care on the place of death and cause of death among centenarians. Centenarians are more likely to die of pneumoniae and frailty and less likely to die of cancers and cerebrovascular disease compared with younger elderly. The analysis of the 2002-2010 National Insurance Health Research Database indicated that 67-73% of the centenarians who passed away died at home while the number of centenarians who died in hospital continued to rise. Hospice home care for centenarians was inadequate compared with non-centenarians. To reduce the reliance on hospital care at the end of life, centenarians needs an enhancement of death literacy. They are more likely to die of acute fatal causes like pneumonia. General provision of advanced care planning and earlier intervention of home hospice care should be promoted to enable these elderly to live their remaining life joyfully.
並列摘要
台灣是全球高齡化速度最快速的國家之一。超長壽常常伴隨著逐步失能，面對生命末期，百歲長者面臨與其他長者不同的死因，相較於其他65歲以上長者，百歲長者的死因常是肺炎及非癌症，且他們較會想要在自己的家中往生而較不想在醫院裡。台灣自2000年以來健保開始給付安寧醫療，成功提升高齡長者的生命末期照護品質，安寧居家醫療也協助病患成功在家中往生。過去沒有研究探討過安寧療護對百歲人瑞死亡地點，及死亡原因做探討。百歲人瑞相較於非百歲老人，容易死於肺炎及老衰，而較不會死於癌症及腦血管疾病，以2002-2010年健保資料看來，約有六成的百歲人瑞死於家中，但死於醫院的比例還是逐年增加。百歲人瑞接受安寧療護的比率不足。未來要減少不必要的住院，及避免非預期的死在醫院裡，對於百歲人瑞的死亡識能還需要被提升，他們較容易死於急性快速的致死原因，如：感染肺炎。此外，未來還需要更廣泛的提供預立醫療諮商及對於百歲人瑞及早的安寧居家服務介入，以幫助這群老人能在自己家中安享天年。