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Samanburður á heilsufari, færni, einkennum og meðferðarmarkmiðum íbúa á íslenskum hjúkrunarheimilum eftir áætluðum lífslíkum

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Authors
Jóhanna Ósk Eiríksdóttir
Helga Bragadóttir
Ingibjörg Hjaltadóttir
Issue Date
2017-12-01

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Other Titles
Comparison of Health Status, Function, Symptoms, and Advance Directives of Nursing Home Residents in Iceland According to Estimated Life Expectancy
Citation
Tímarit hjúkrunarfræðinga 2017, 93(3):79-85
Abstract
Tilgangur: Á síðustu árum hefur dvalartími íbúa á íslenskum hjúkrunarheimilum styst og því hafa margir þeirra þörf fyrir líknarmeðferð og umönnun við lífslok fljótlega eftir flutning þangað. Mikilvægt er að þekkja breytingar á heilsufari og einkennum sem verða þegar nær dregur lífslokum svo að íbúarnir fái viðeigandi umönnun og líði sem best. Tilgangur rannsóknarinnar var að varpa ljósi á heilsufar, færni, einkenni og meðferðarmarkmið íbúa á hjúkrunarheimilum, sem hafa hálfs árs lífslíkur eða minni, og bera saman við aðra íbúa. Aðferð: Rannsóknin var lýsandi þversniðs- og samanburðarrannsókn byggð á fyrirliggjandi RAI-gögnum (e. Resident Assessment Instrument) frá íbúum allra hjúkrunarheimila á Íslandi. Kvarðar og breytur, sem lýsa heilsufari, færni, einkennum og meðferðarmarkmiðum, byggðust á síðasta mati ársins 2012 (N=2337). Lífslíkur íbúa voru áætlaðar í sama mati og flokkaðar í annars vegar hálft ár eða minna og hins vegar meira en hálft ár. Niðurstöður: Meðalaldur var 84,7 ár (sf=8,2; spönn=20–106 ár) og hlutfall kvenna var 65,6%. Heilsufaríbúa með minni lífslíkur var verra en annarra íbúa. Vitræn geta mæld á vitrænum kvarða (0–6) var að meðaltali 5,0 (sf=1,3) meðal íbúa með minni lífslíkur en hálft ár, en annarra 3,3 (sf=1,8), p<0,001. Færni þeirra var einnig verri, meðaltal á löngum ADL-kvarða (0-28) var 26,3 (sf=3,0) samanborið við 16,5 (sf=8,3), og byltur voru einnig algengari (27,9%) en meðal annarra íbúa (12,8%), p<0,001. Íbúar með minni lífslíkur voru með meiri verki og önnur erfið einkenni heldur en aðrir íbúar. Hlutfallslega helmingi fleiri voru með verki daglega (61,3%) og þeir voru einnig oftar með slæma eða óbærilega verki (42,7%) en aðrir (14,8%), p<0,001. Ályktanir: Niðurstöðurnar staðfesta mikla umönnunarþörf og erfið einkenni þeirra sem dvelja á hjúkrunarheimilum, einkum þeirra sem eru með skemmri lífslíkur. Leggja þarf áherslu á fræðslu og þjálfun starfsfólks, ásamt breyttu mönnunarfyrirkomulagi í samræmi við heilsufar og þarfir þessa hóps.
Aim: As length of stay has shortened in Icelandic nursing homes, many residents are in need of palliative care. It is important to recognize changes in symptoms and health status as death approaches in order to provide adequate care. The aim of this study was to compare the health status, function, symptoms, and advanced directives in residents with estimated life expectancy of six months or less with other residents. Method: This was a descriptive, cross-sectional, comparison study, based on ResidentAssessment Instrument data (RAI)from all nursing home residentsin Iceland. Data on health status, function,symptoms, and advanced directives, from the latest assessment in the year 2012 were used (N=2337). Life expectancy was categorized during this data collection into six months or less (shorter) or longer. Results: The mean age of participants was 84.7 (SD=8.2; range=20- 106) and women were 65.6%. The health status of residents with shorter life expectancy was worse than in other residents. Mean score on the Cognitive Performing Scale (0–6) was 5.0 (SD=1.3) in those with shorter life expectancy compared to others (3.3, SD=1.8), p<0.001. Their functional status was also worse, mean score on the long-ADL scale (0–28) was 26.3 (SD=3.0) compared to 16.5 (SD=8.3) in other residents, and frequency of falls was higher (27.9%) than in other residents (12.8%), p<0.001. Pain and othersymptoms were more prevalent in residents with shorterthan longer life expectancy, more than half had daily pain (61.3%), and a higher proportion had severe or unbearable pain (42.7%) than residents with longer life expectancy (14.8%), p<0.001. Conclusion: Nursing home residents have many difficult symptoms and need substantial care-giving, particularly those with shorter life expectancy. There is a need for education and training of nursing staff, as well as changes in staffing, to meet the needs of Icelandic nursing home residents.
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https://www.hjukrun.is/library/Skrar/Timarit/Timarit-2017/3-tbl-2017/SamanburdurAHeilsufari.pdf
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