- 1、本文档共25页,可阅读全部内容。
- 2、原创力文档(book118)网站文档一经付费(服务费),不意味着购买了该文档的版权,仅供个人/单位学习、研究之用,不得用于商业用途,未经授权,严禁复制、发行、汇编、翻译或者网络传播等,侵权必究。
- 3、本站所有内容均由合作方或网友上传,本站不对文档的完整性、权威性及其观点立场正确性做任何保证或承诺!文档内容仅供研究参考,付费前请自行鉴别。如您付费,意味着您自己接受本站规则且自行承担风险,本站不退款、不进行额外附加服务;查看《如何避免下载的几个坑》。如果您已付费下载过本站文档,您可以点击 这里二次下载。
- 4、如文档侵犯商业秘密、侵犯著作权、侵犯人身权等,请点击“版权申诉”(推荐),也可以打举报电话:400-050-0827(电话支持时间:9:00-18:30)。
查看更多
Cultural Considerations in Palliative Practice for Native Americans
Cultural Considerations in Palliative Practice for Native AmericansGeriatric Grand RoundsUNMApril 9, 2009Timothy Domer MDFort Defiance AZ
88 yo Navajo female, advanced Parkinson’s, assist will all ADLs
ED with hypoxia, hypotension, bilateral infiltrates, unable to adequately oxygenate, intubated, pressors.
Baseline alb. 1.8
Now in ICU after 4 days, CXR is worse, 70% FiO2, requiring low dose pressors, PEEP, third-spacing
No AD, no MDPA
Causes of death US vs.. Native Americans
US top 11 (CDC 2004): AI/AN (2000)
Heart Disease Heart disease
Malignancies Malignancies
CVA Unintentional injuries
COPD Diabetes
Unintentional injuries CVA
Diabetes Liver disease
Alzheimer’s COPD
Acute resp. illness Suicide
Renal disease Acute resp. illness
Septicemia Renal disease
Suicide Homicide
15 Alzheimer’s
Death rates are significantly higher for:
Alcoholism 638 %
Tuberculosis 400%
Diabetes mellitus 291%
Unintentional injuries 215%
Suicide 91%
Homicide 81%
Pneumonia and influenza 67
Gastrointestinal diseases 38%
Heart disease 20%
Malignant neoplasms 1% lower
HIV disease is 43% less.
Epidemiology
CDC US 2004 Expected Life
Males 75.7 yrs (white) 69.8 (black)
Females 80.8 yrs 76.6
CDC/IHS Navajo Area 1999 Expected Life
Males 66.1yrs
Females 77.5 yrs
Average age at death FDIH past 2 years:
Males 56 years (US 75 years)
Females 64 years (US 80 years)
Hospice Usage:
2004 (31%) Medicare decedents opted for hospice - up from 22 percent in 2000
CMMS: Report to Congress: Increasing the Value of Medicare, June 2006
/publications/congressional_reports/Jun06_TOC.pdf
1999-2003 (2.8%) IHS Medicare patients in 2 IHS hospitals enrolled in hospice when they died - State average - 30.8%.
Dartmouth Atlas utilization data, NM Medical Review Association (NMMRA), the Medicare Quality Improvement Organization for New Mexico () (.shtm)
Tribal and regional diversity:
Each Tribe has unique traditions, customs and beliefs.
Variation in
您可能关注的文档
- Charlotte+Brontes+Feminine+consciousness+in+Jane+Eyre.pdf
- Charm Dalitz Plot Analysis Formalism and Results.pdf
- Charm and beauty production at CDF.pdf
- Charm Estimate from the Dilepton Spectra.pdf
- Charm and beauty of the Large Hadron Collider.pdf
- Charm Hadron Production Fractions.pdf
- Charm coalescence at relativistic energies.pdf
- Charm Leptonic and Semileptonic Decays.pdf
- Charm meson production from meson-nucleon scattering.pdf
- Charm meson resonances in $D to P ell nu$ decays.pdf
最近下载
- 第18章中国传媒业的新生态、新业态《网络与新媒体概论》教学课件.ppt VIP
- 三相桥式可控整流电路设计..doc
- 第17章互联网与网民素养《网络与新媒体概论》教学课件.ppt VIP
- 第14章互联网与精准营销《网络与新媒体概论》教学课件.ppt VIP
- 《典型灾害应急实训》课程大纲(本科).docx VIP
- 第12章互联网与社会思潮《网络与新媒体概论》教学课件.ppt VIP
- 护士N2晋级N3述职报告PPT.pptx
- 《人力资源规划HRP》课件.pptx VIP
- 第9章互联网与民主政治建设《网络与新媒体概论》教学课件.pptx VIP
- (新版)高级考评员职业技能鉴定考试题库(含答案).docx
文档评论(0)