Mechanical Ventilation in Older Adults With Dementia: Opportunities to Promote Goal-Concordant Care.
J Pain Symptom Manage
; 68(2): 142-152.e2, 2024 Aug.
Article
em En
| MEDLINE
| ID: mdl-38685288
ABSTRACT
CONTEXT Recent studies show increasing use of mechanical ventilation among people living with dementia. There are concerns that this trend may not be driven by patient preferences. OBJECTIVES:
To better understand decision-making regarding mechanical ventilation in people living with dementia.METHODS:
This was an electronic health record-based retrospective cohort study of older adults with dementia (n = 295) hospitalized at one of two teaching hospitals between 2015 and 2019 who were supported with mechanical ventilation (n = 191) or died without mechanical ventilation (n = 104). Multivariable logistic regression was used to examine associations between patient characteristics and mechanical ventilation use.RESULTS:
The median age was 78 years (IQR 71-86), 41% were female, 28% resided in a nursing home, and 58% had clinical markers of advanced dementia (dehydration, weight loss, mobility limitations, or pressure ulcers). Among patients supported with mechanical ventilation, 70% were intubated within 24 hours of presentation, including 31% intubated before hospital arrival. Younger age, higher illness acuity, and absence of a treatment-limiting Physician Orders for Life-Sustaining Treatment document were associated with mechanical ventilation use; nursing home residence and clinical markers of advanced dementia were not. Most patients (89%) had a documented goals of care discussion (GOCD) during hospitalization.CONCLUSION:
Future efforts to promote goal-concordant care surrounding mechanical ventilation use for people living with dementia should involve identifying barriers to goal-concordant care in pre-hospital settings, assessing the timeliness of in-hospital GOCD, and developing strategies for in-the-moment crisis communication across settings.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Respiração Artificial
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Demência
Limite:
Aged
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Aged80
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Female
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Humans
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Male
Idioma:
En
Revista:
J Pain Symptom Manage
Assunto da revista:
NEUROLOGIA
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PSICOFISIOLOGIA
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TERAPEUTICA
Ano de publicação:
2024
Tipo de documento:
Article