Type and course of symptoms demonstrated in the terminal and dying phases by people with dementia in nursing homes

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• 作者：A. Koppitz (1)
  G. Bosshard (2)
  D.H. Schuster (1)
  H. Hediger (1)
  L. Imhof (1)
  
  1. Institute of Nursing ; Zurich University of Applied Sciences (ZHAW) ; Technikumstr. 71 ; 8404 ; Winterthur ; Switzerland
  2. Clinic for Geriatric Medicine ; and Center on Aging and Mobility ; University Hospital of Zurich ; University of Zurich ; Zurich ; Switzerland
  
• 关键词：Dementia ; Nursing home ; Symptoms ; Palliative care ; Terminal phase ; Demenz ; Pflegeheim ; Symptome ; Palliative Care ; Terminalphase
• 刊名：Zeitschrift f篓鹿r Gerontologie und Geriatrie
• 出版年：2015
• 出版时间：February 2015
• 年：2015
• 卷：48
• 期：2
• 页码：176-183
• 全文大小：851 KB
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• 刊物主题：Geriatrics/Gerontology; Internal Medicine; Aging; Social Sciences, general;
• 出版者：Springer Berlin Heidelberg
• ISSN：1435-1269

文摘

Background In all, 39鈥? of people living in Swiss nursing homes suffer from dementia. Detailed data about type and course of symptoms displayed by these patients in their terminal phase are lacking. Methods This descriptive, retrospective study analysed 65聽nursing documents from deceased people with dementia in four nursing homes in the canton of Zurich, Switzerland. Results Difficulties with mobility (81鈥?), pain (71鈥?) and sleep disturbance (63鈥?) were the most frequent of the 10聽identified symptoms. Towards the end of life, difficulties with mobility, sleep disturbance, agitation and other neuropsychiatric symptoms, such as episodes of depression, decreased (decrescent pattern), while pain, feeding problems, breathing abnormalities, apathy and anxiety increased (crescent pattern). Courses of pain were documented in 17鈥? of the nursing records. In addition, 76鈥? of the residents had been visited on a daily basis by next of kin in their last 7聽days, compared with only one third of residents previously. Furthermore, daily communication between healthcare professionals and next of kin tripled during this period. Conclusion The documented prevalence of a high and increasing level of pain towards the end of life, combined with the lack of documented courses of pain, shows potential for improvement in pain relief and pain identification for patients with dementia in their terminal phase. The increasing number of visits by next of kin and the increasingly intensive contact between healthcare professionals and next of kin in the last 7聽days are a strong indicator that the end of life can be predicted relatively well by the involved participants and appropriate reactions follow.