Using the Minimum Data Set to Determine Predictors of Terminal Restlessness among Nursing Home Residents

Translated Titles



李鳳屏(Feng-Ping Lee);Carol Leppa;Karen Schepp

Key Words

長者健康評估工具MDS ; 臨終躁動不安 ; Minimum Data Set MDS ; terminal restlessness


The Journal of Nursing Research

Volume or Term/Year and Month of Publication

14卷4期(2006 / 12 / 01)

Page #

286 - 296

Content Language


Chinese Abstract

本研究之目的在測定自長者健康評估工具(Minimum Data Set, MDS)中所選取的四個變項(疼痛、憂鬱情緒、問題狀況及藥物使用)是否為護理之家住民臨終躁動不安之預測因子。本研究乃採橫斷、描述性設計,回溯居住於美國西北部某一護理之家在西元2000及2001年過世住民的最後一次MDS紀錄。以臨終躁動不安做為依變項,疼痛、憂鬱情緒、問題狀況及藥物使用四個變項為自變項,運用徑路分析統計方法探討此四變項是否可預測住民臨終躁動不安的情形。結果共有84位住民紀錄納入本研究,徑路分析顯示:(1)住民的問題狀況(β=.557)及疼痛(β=.193)可預測住民憂鬱情緒變異量的44.6%;(2)疼痛(β=.370)及憂鬱情緒(β=.313)可預測住民臨終躁動不安變異量的34%。本研究發現具有重要之臨床意義,尤其許多年老住民在臨終時無法以口語溝通,審慎地評估住民臨終時疼痛狀況及情緒變化是必要的,藉以提供合適且立即性的措施。

English Abstract

The aim of this study was to determine predictive variables of terminal restlessness that were selected from the Minimum Data Set (MDS) among nursing home residents. A descriptive, cross-sectional design was used to retrospectively review decedents' Minimum Data Set records. Four independent variables from the MDS (distressed mood, problem conditions, pain, and medications) were examined as to whether they were predictive variables of terminal restlessness by utilizing path analysis statistical method. Residents from a nursing home located in the northwestern United States who died during 2000 and 2001, had at least one MDS record and no comatose in their MDS cognitive patterns were selected. A total of 84 decedents’ records were consequently recruited for use in this study. A path analysis result showed (a) 44.6% of the variance in distressed mood is predicted by two variables: problem conditions (β=.557) and pain (β=.193) and (b) 34% of the variance in terminal restlessness is predicted by two variables: pain (β=.370) and distressed mood (β=.313). Results indicate that residents who (a) had more problem conditions and more pain are more likely to have distressed moods and (b) experienced more pain and had more distressed moods have a higher incidence of terminal restlessness. These findings provide important and valuable clinical implications. A careful evaluation of pain is necessary, especially as many elders are not able to communicate well during the terminal phase of their lives. How to access residents' moods and provide appropriate and immediate interventions, comfort, and even just being there for them are imperative for nursing home care providers.

Topic Category 醫藥衛生 > 預防保健與衛生學
醫藥衛生 > 社會醫學
  1. Asher, H. B.(1983).Causal modeling.Beverly Hills, CA:Sage.
  2. Back, I. N.(1992).Terminal restlessness in patients with advanced malignant disease.Palliative Medicine,6,293-298.
  3. Baines, M. J.,N. Sykes (Ed.)(1993).The management of terminal malignant disease.London:Edward Arnold.
  4. Blanchette, H.(2005).Assessment and treatment of terminal restlessness in the hospitalized adult patient with cancer.Medsurg Nursing,14(1),17-22.
  5. Boyle, D. M.,Abernathy, G.,Baker, L.,Wall, A. C.(1998).End-of-life confusion in patients with cancer.Oncology Nursing Forum,25(8),1335-1343.
  6. Breitbart, W.,Strout, D.(2000).Delirium in the terminally ill.Clinics in Geriatrics Medicine,16(2),231-237.
  7. Burke, A.(1997).Palliative care: An update on terminal restlessness.Medical Journal of Australia,166(1),39-42.
  8. RAI user's manual
  9. Coyle, N.,Breitbar, W.,Weaver, S.,Portenoy, R.(1994).Delirium as a contributing factor to "crescendo" pain: Three case reports.Journal of Paim and Symptom Management,9(1),44-47.
  10. de Stoutz, N. D.,Tapper, M.,Fainsinger, R. L.(1998).Reversible delirium in terminally ill patients.Journal of Pain and Symptom Management,10(3),249-253.
  11. Dean, G. E.(1996).Symptom management for the dying patient.Journal of Pain and Symptom Management,3,61-63.
  12. A profile of older Americans: 2004
  13. Derogaits, L. R.,Morrow, G. R.,Fetting, J.,Penman, D.,Piasetsky, S.,Schmale, A. M.(1983).The prevalence of psychiatric disorders among cancer patients.Journal of the American Medical Association,249,751-757.
  14. Elder, G. H.,Pavalko, E. K.,Clipp, E. C.(1993).Working with archival data: Studying lives.Newbury, CA:Sage.
  15. Enck, R. E.(1992).The last few days.American Journal of Hospice and Palliative Care,9(4),11-13.
  16. Ferell, B. A.,Ferrell, B. R.,Rivera, L.(1995).Pain in cognitively impaired nursing home patients.Journal of Pain Symptom Management,10(8),591-598.
  17. Field, M. M.,Cassel, C. K.(1997).Approaching death: Improving care at the end of life.Washington. DC:National Academy Press.
  18. Frederiksen, K.,Tariot, R.,DeJonghe, E.(1996).Minimum Data Set Plus (MDS+) scores compared with scores from five rating scales.Journal of American Geriatrics Society,44(3),305-309.
  19. Gambassi, G.,Landi, F.,Peng, L.,Brostrup-Jensen, C.,Cabre, K.,Hiris, J., et al.(1998).Validity of diagnostic and drug data in standardized nursing home resident assessments: Potential for geriatric pharmacoepidemiology. SAGE study group. Systematic assessment of geriatric drug use via epidemiology.Medical Care,36(2),167-179.
  20. Higginson, J.,McCarthy, M.(1989).Measuring symptoms in terminal cancer: Are pain and dyspnea controlled?.Journal of the Royal Society of Medicine,82(5),264-267.
  21. Hinshaw, A. S.(1984).Theoretical model testing: Full utilization of data.Western Journal of Nursing Research,6(1),5-9.
  22. Jackson, K. C.,Lipman, A. G.(2004).Drug therapy for delirium in terminally ill patients.The Cochrane Database of Systematic Reviews 2004.
  23. Jones, C. L.,King, M. B.,Speck, R.,Kurowska, A.,Tookman, A. J.(1998).Development of an instrument to measure terminal restlessness.Palliative Medicine,12(2),99-104.
  24. Kehl, K. A.(2004).Treatment of terminal restlessness: A review of the evidence.Journal of Pain & Palliative Care Pharmacotherapy,18(1),5-30.
  25. Lawlor, P. G.,Gagnon, B.,Mancini, I. L.,Pereira, J. L.,Hanson, J.,Suarez-Almazor, M. E., et al.(2000).Occurrence, causes, and outcome of delirium in patients with advanced cancer: A prospective study.Archives of Internal Medicine,160(6),786-794.
  26. Lawlor, R G.,Fainsinger, R. L.,Bruera, E. D.(2000).Delirium at the end of life: Critical issues in clinical practice and research.Journal of American Medical Association,284(19),2427-2429.
  27. Leipzig, R.,Goodman, H.,Erle, H.,Reidenberg, M. M.(1987).Reversible, narcotic-associated mental status impairment in patients with metastatic cancer.Pharmacology,35(1),47-54.
  28. Lichter, I.,Hunt, E.(1990).The last 48 hours of life.Journal of Palliative Care,6(4),7-15.
  29. March, P. A.(1998).Terminal restlessness.American Journal of Hospice and Palliative Care,15(1),51-53.