老人末期照顧新進展 - tma.tw.pptVIP

生命末期社區照護之團隊 台大醫院雲林分院 社區及家庭醫學部 彭仁奎 醫師 Comparison of Increasing Aged Proportion in Various Countries 97年台灣死因統計 惡性腫瘤 27.3% 心臟疾病 11.1% 腦血管疾病 7.5% 肺炎 6.1% 糖尿病 5.6% 事故傷害 5% 慢性下呼吸道疾病 3.8% 慢性肝病及肝硬化 3.5% 自殺 2.9% 腎炎、腎徵候群及腎性病變 2.8% 敗血症 2.5% 高血壓性疾病 2.5% 衰老/老邁 1.1% 生命末期的功能衰退 安寧緩和醫療的定義 WHO definition (1990) The active total care of those patients whose disease is not responsive to curative therapy. Control of pain, and of other symptoms, and of psychological and spiritual problems, is paramount. The goal of palliative care is achievement of the best quality of life for the patients and their families. Many aspects of palliative care are also applicable earlier in the course of the illness in conjunction with anticancer treatment. 安寧緩和醫療的定義 WHO definition (2002) An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable treatment of pain and other problems, physical, psychological and spiritual. 安寧緩和醫療的定義 對象：末期病患?任何可能進展至死亡的疾病患者，及其家屬 積極治療，以緩解（甚至預防）身體、心理、社會、靈性的苦痛（suffering） 目標：提升病人與家屬的生活品質 及早介入，幫助更大 面對生命末期（無論診斷別）的病患，我們在社區照護方面是否已經做好準備？ 能不能建構有效的團隊與運作模式，來幫助生命末期病患在社區中得到好的照護？ 社區的醫師、護士準備好了嗎？ MDS Full Report for the year (2005-2006)National Council for Palliative Care (NCPC) NHS End of Life Care Program (2004–2007) Gold Standards Framework (GSF) Liverpool Care Pathway for the Dying Patient (LCP) Preferred Priorities for Care (PPC) Three triggers for Supportive/ Palliative Care The surprise question “Would you be surprised if this patient were to die in the next 6-12 months?” Choice/ Need The patient with advanced disease makes a choice for comfort care only, not ‘curative’ treatment, or is in special need of supportive / palliative care. Clinical indicators The End of Life Care Pathway Step 1: discussions as end of life approaches Open, honest communication Identifying