[The present state and subject of home hospice for patients with non-cancer disorders].
In order to clarify the issues regarding home hospice for patients with non-cancer disorders, the patients' death at home was compared with that of terminal cancer patients treated in our clinic. The following results were obtained: In the non-cancer disorder group, the number of deaths of female patients was greater than that of male patients. In this same group, the average age of patients at death was greater by 6.7 years and the period of home care was longer than that in the terminal cancer group. The underlying diseases in the cases belonging to the non-cancer disorder group were mainly dementia, chronic respiratory failure, intractable neurological disease, and cerebral stroke. Complicated palliative care was not essential during the medical treatment of cases with non cancer disorders, unlike in cases of terminal cancer. The amounts of opioid consumed during home hospice and the frequency of transfusion on and before the day of death at home in the non-cancer disorder group were less than those in the terminal cancer group. In the non-cancer disorder group, death was predicted in 57.1% of the cases. It was relatively easy to presume the prognosis in patients with chronic respiratory failure, intractable neurological disease, or renal failure who preferred not to receive life-prolonging medical treatment and in the cases with dementia. However, this did not hold true for patients with cerebral stroke. With regard to patients who had diseases other than dementia and who preferred not to receive life-prolonging medical treatment, their living-will was an essential factor in the decision making process. However, for the patients with dementia, a consensus-based approach involving both the patients' family and the healthcare worker was important. In the future, it is essential to consider the procedures of hospice care for the patients with non-cancer disorders based on a disease structure, a medical system, and values in Japan.
Hirahara
Satoshi
S
Kajiwara Clinic, Tokyo Fureai Medical Cooperation.
D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D003704:Dementia / Q000451:nursing; D005260:Female; D006333:Heart Failure / Q000451:nursing*; D006699:Home Care Services; D017051:Hospice Care / Q000379:methods*; D006801:Humans; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000451:nursing*; D020521:Stroke / Q000451:nursing