失智症住院病人的安寧照護－北區某區域教學醫院經驗分享

Palliative Care in Hospitalized Dementia Patients: Experiences from One Community Teaching Hospital in Northern Taiwan

洪玉馨(Yu-Shin Hung) ； 吳維珊(Wei-Shan Wu) ； 黃韻琴(Yun-Chin Huang) ； 章甄凌(Chen-Ling Chang) ； 林均澄(Jun-Cheng Lin) ； 徐海蓓(Hai-Pei Hsu) ； 周文其(Wen-Chi Chou)

《安寧療護雜誌》 15卷2期 (2010/07) Pp. 161-170

https://doi.org/10.6537/TJHPC.2010.15(2).2

摘要

目的：失智症病人對安寧照護的需求越來越受到重視，本研究的目的主要是爲了解失智症住院病人常見的臨床症狀及探討其對安寧照護的需求性。
方法：這是回溯性的研究。我們將曾於本院接受神經生理檢查確診罹患失智症，且在2007年9月1日至2009年12月31日住院期間接受本院安寧共同照護的病人列入研究對象。
結果：共有14位病人符合收案條件，8位男性，6位女性，平均年齡爲84.4歲。平均每位病人有9.5項臨床症狀，前五項分別是疲倦(93%)、發燒(86%)、咳嗽(86%)、水腫(79%)及呼吸困難(71%)。14主要照顧的家屬中，有8位(57%)家屬對病人的病情及預後認知有疑慮，有6位(43%)家屬於簽署不施行心肺復甦術同意書的過程中出現嚴重的情緒困擾。全部病人接受安寧照護的平均日數爲12.5日（1-31日），平均存活期爲192日（1-908日），中位數存活期爲91日。
結論：失智症晚期病人因併發症急性住院時，其出現的臨床症狀是多樣性的，及早了解此群病人常見的症狀，方能及早介入處置。目前缺乏準確客觀的評估量表來決定失智症病人接受緩和醫療的適當時機，我們建議當失智症病人無生活自理能力且出現急性醫療需求時，就是安寧療護應當介入的時機。

關鍵字

失智症 ； 安寧照護 ； 症狀

並列摘要

Background: There is a growing trend (need) of applying (providing) palliative care in dementia patients. The goal of this study is to access the common symptoms among hospitalized dementia patients and their needs of palliative care.
Methods: This was a retrospective study. Patients who were hospitalized between September 2007 to December 2009 and under palliative care were included. They were diagnosed with dementia under documented neurophysiologic examination.
Results: Total 14 patients were enrolled in this study, 8 males and 6 females. The median age was 84.4 years; the mean number of symptoms recorded was 9.5. The five leading symptoms were fatigue (93%), fever (86%), cough (86%), edema (79%) and dyspnea (71%). Eight of 14 proxies were not aware of the prognosis of the patient; six proxies had serious emotional conflict when signing do not resuscitate consent. The mean duration of palliative care for all the patients was 12.5 days. Their mean survival time was 192 day, and the median survival time was 91 days.
Conclusion: The clinical symptoms in hospitalized dementia patients were polysymptomatic. Early identification of their distressing symptoms helps medical staff to provide early interventions. There was no accurate and objective neurophysiologic scale test to determine the exact timing to receive palliative care in dementia patients. We suggested that it would be the time for palliative care intervention when dementia patients lost their self-care abilities and needed medical treatment because acute illness.

並列關鍵字

dementia ； palliative care ； symptoms