RESUMO
PURPOSE: Palliative Care Outcomes Collaboration (PCOC) is an internationally recognized program developed in Australia. Taiwan became the first country in Asia to implement PCOC in 2020. There is little research on the impact of PCOC in Asia. We sought to examine the effects of the Taiwan PCOC on palliative outcomes. METHODS: The study analyzed the impact of PCOC with a retrospective cohort design. The hypotheses were that PCOC could improve end-of-life care quality and reduce non-beneficial treatments. The study enrolled patients with terminal illnesses from the inpatient palliative care units. General characteristics of participants were collected. Exclusion criteria were people without a diagnosis of terminal illness, aged 20 and younger, or with missing data. RESULTS: The study collected 1,121 patients, 555 in the PCOC comparison group and 566 in the intervention group. Most patients were with terminal cancer (88.58%). The rates of hospital deaths in the PCOC and non-PCOC groups were 68.73% vs. 74.95% (P = 0.021). A multivariable logistic regression model, adjusting for age, sex, Charlson comorbidity index, and terminal cancer status, was utilized. The PCOC intervention significantly decreased hospital deaths (OR = 0.26, 95%CI 0. 16-0.41, P < 0.001). CONCLUSIONS: PCOC in Taiwan significantly reduced hospital deaths among terminal patients, possibly due to effective symptom management and improved communication via the use of patient-reported outcomes. Further research is needed to support PCOC implementation in Asia and investigate collaboration programs' impact on end-of-life care quality and non-beneficial treatments.
Assuntos
Cuidados Paliativos , Assistência Terminal , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/organização & administração , Masculino , Feminino , Estudos Retrospectivos , Assistência Terminal/métodos , Taiwan , Idoso , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Qualidade da Assistência à Saúde , Mortalidade Hospitalar , Neoplasias/terapia , Adulto , Modelos Logísticos , Estudos de CoortesRESUMO
PURPOSE: Palliative home care services (PHCS) have been emerging for years. However, limited data exist regarding quality indicators for pain control, unplanned hospital readmissions, and household deaths among terminal cancer and non-cancer patients receiving PHCS. METHODS: We conducted a retrospective collection and recording of data from 1242 terminally ill cancer and non-cancer patients receiving PHCS. The data were obtained from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH) for the period from 2016 to 2021. T test and chi-square test were applied for characteristics and the quality indicators among cancer and non-cancer groups. Chi-square test was used for trend analysis of the number of patients receiving PHCS and the quality indicators among cancer and non-cancer groups throughout the study period. RESULTS: A total of 1242 terminally ill cancer and non-cancer patients who had received PHCS were documented by TCVGH from the years 2016 to 2021, including 221 non-cancer patients and 1021 cancer patients having an average age of 70. The number of terminally ill cancer and non-cancer patients receiving PHCS has increased annually since 2016. Another finding was that age was a statistically significant factor impacting quality indicators. On the other hand, compared to non-cancer patients, cancer patients had a higher likelihood of receiving treatment with analgesics when needed. Their odds of needing analgesics more than three times within 4 days after PHCS enrollment were significantly elevated [OR 4.188, 95% CI (1.002, 17.51)]. CONCLUSION: The results of this 6-year observational study indicate a substantial increase in the number of terminal cancer and non-cancer patients receiving PHCS over the past decade. Furthermore, aging plays an important role in life quality of terminal cancer and non-cancer patients.
Assuntos
Serviços de Assistência Domiciliar , Neoplasias , Humanos , Idoso , Doente Terminal , Estudos Retrospectivos , Taiwan , Indicadores de Qualidade em Assistência à Saúde , Cuidados Paliativos/métodos , Neoplasias/terapia , AnalgésicosRESUMO
BACKGROUND: Day care service (DCS) provides various activities in a professional environment to meet the old people with functional limitations. However, relatively little is known about the effects of DCS on physical and mental functions. METHODS: This was a retrospective study that we used a comprehensive geriatric assessment to evaluate the changes before and after DCS among participants in a hospital-affiliated geriatric day care center in Taiwan. The burden of the participants' families was also assessed. RESULTS: The 18 participants with a median age of 80.9 (interquartile range (IQR) 75.2-86.6 y/o) were enrolled and followed up for 6 months. Based on the clinical dementia rating (CDR), disease stage was very mild in 3 participants, mild in 10, moderate in 3, and severe in 2. The activities of daily living (ADL) scores of the participants improved significantly from 75 (IQR 60.0-80.0) at baseline to 77.5 (IQR 65.0-90.0) at the 6 month (p < 0.001), and mini-mental state examination (MMSE) scores from 15 (IQR 11.5-20.0) to 18 (IQR 15.8-24.0) (p = 0.026). There was a positive correlation of baseline mini-nutritional assessment-short form score and the 3-level version of the European Quality of Life-5 dimensions utility index with both ADL and MMSE scores at the 6-month follow-up. In addition, the family burden scale was reduced from 22 to 15 (p = 0.002). CONCLUSIONS: The physical and cognitive functions in old people with dementia who received DCS were maintained or partially improved, and their families' stress burden was alleviated.
Assuntos
Atividades Cotidianas , Cognição , Hospital Dia/psicologia , Demência/psicologia , Estado Funcional , Idoso , Idoso de 80 Anos ou mais , Cuidadores/psicologia , Feminino , Avaliação Geriátrica , Humanos , Masculino , Testes de Estado Mental e Demência , Avaliação Nutricional , Qualidade de Vida , Estudos Retrospectivos , TaiwanRESUMO
BACKGROUND: Chronic kidney disease (CKD), low serum albumin, and anemia are known risk factors for cognitive decline in older people. We investigated the association between kidney function and cognitive impairment severity in oldest-old people with a diagnosis of Alzheimer's disease (AD). METHODS: A cross-sectional study of patients aged 80 years and older was conducted at a veterans' home in Taiwan between 2012 and 2016. Their estimated glomerular filtration rate (eGFR) was determined using the Modification of Diet in Renal Diseases (MDRD) equation. Cognitive function was evaluated with the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR). RESULTS: A total of 84 patients (age mean ± SD, 86.6 ± 3.9 years) had MMSE scores of 10.1 ± 6.7, and CDR scores of 1.6 ± 0.7. The average eGFR was 61.7 ± 21.5 mL/min/1.73m2. The mean hemoglobin concentration was 12.7 ± 1.7 g/dl, and the mean albumin concentration was 4.5 ± 4.8 g/dl. Multivariate regression analyses showed that scores of CDR were significantly correlated with eGFR after adjustment for potential confounders. The scores of MMSE were significantly correlated with serum albumin and hemoglobin after adjustment for potential confounders. CONCLUSIONS: We found dementia severity was significantly associated with kidney function, serum albumin, and hemoglobin in the oldest-old with AD. We recommend that oldest-old people with a diagnosis of AD be evaluated to determine kidney function, as well as nutritional and hematological status. Further study is needed to establish whether prevention of CKD deterioration, and correction of malnutrition and anemia may help to slow cognitive decline in oldest-old people with dementia.
Assuntos
Doença de Alzheimer/sangue , Taxa de Filtração Glomerular/fisiologia , Hemoglobinas/análise , Albumina Sérica/análise , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/epidemiologia , Estudos Transversais , Feminino , Humanos , Testes de Função Renal/métodos , Masculino , Índice de Gravidade de Doença , Taiwan/epidemiologiaRESUMO
We assessed the characteristics and perception of telephone appointments among outpatients and medical staff during the COVID-19 pandemic in Taiwan. Our survey was performed by giving self-administered questionnaires to the enrollees. Basic socioeconomic status data were collected. We used a valid and reliable telehealth usability questionnaire (TUQ) to assess the telemedicine experience among outpatients and medical staff. Only outpatients with chronic illness and who had regular visits before the pandemic were enrolled. We delivered the questionnaire survey to participants who used telephone appointments from 20 May 2021 to 31 July 2021 in Taichung Veterans General Hospital. A total of 471 outpatients and 203 medical staff completed the survey. Most of the respondents were aged 30-69, college-educated, women, and married. Outpatients have higher scores in all dimensions of TUQ than medical staff, especially in the dimensions of ease of use and effectiveness. Age, gender, education, and marriage have no significant associations in the medical staff group. In the outpatient group, gender is the only significant factor in the six dimensions of TUQ. We found a significant disparity in the perception gap of telemedicine among outpatient and medical staff. Outpatients are satisfied with telephone appointments during the COVID-19 pandemic, but medical staff are concerned about the ease of use and effectiveness.