特別養護老人ホームにおける看取りケアの経緯と医師の役割

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  • Continuation of end-of-life care in a special elderly nursing home and the role of doctors
  • トクベツ ヨウゴ ロウジンホーム ニ オケル ミトリ ケア ノ ケイイ ト イシ ノ ヤクワリ

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Aim: As 2 years have passed since its implementation, and we have received several comments regarding our original article, we report the recent developments of end-of-life (EOL) care in a special elderly (SE) nursing home and describe the role of doctors.<br> Participants: A total of 7 female EOL care patients (age, 101.5±4 years) in a special elderly home and 130 patients (98 years, 42 men, 88 women; age, 87±6.5 years) receiving palliative therapy in a hospital.<br> Results: Four of the 7 EOL care patients died after an average of 480±297 days within our EOL care system, while 3 patients spent an average of 805±662 days in our SE home. Among the hospitalized patients, 93 (71.5%; 27 men and 66 women; age, 86.7±10 years) were able to be discharged to our facility, whereas 37 (28.5%; 15 men, 22 women; age, 86.4±11 years) died during hospital care. A number of patients who could discharge had a greater incidence of gastrointestinal disorders than congestive heart failure (p<0.05). Among 15 patients (≥98 years) who could not enter EOL care because of family problems, 12 were hospitalized and 9 died before discharge. This number was significantly greater than the number who died before discharge and who were <98 years (p<0.05). One patient (aged 103 years) who had a solid breast tumor successfully underwent surgery and was discharged after 3 days of admission, but she died within 90 days of EOL. The death rates in our nursing home were significantly lower than the average death rate in other facilities (15.3% vs. 37.2%, p<0.01).<br> Conclusion: Patients of over 98 years old did not live longer, despite hospitalized care; however, the number of patients (28%) who were less than 98 years could be discharged and were alive was significantly less than centenarians (p<0.05). Doctors in nursing homes should provide communication support for nursing homes and hospitals after providing medical education for care workers.<br>

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