緩和ケアでの転倒：深刻な問題

タイトル: Prevalence of falls in the last weeks of life and relationship between falls, independence, and quality of dying: A secondary analysis of a large prospective cohort study

概要: ObjectiveTo determine the frequency of falls and their serious complications in palliative care units (PCUs), as well as explore the complex interplay between falls, independence, and quality of dying. MethodsA secondary analysis of a large prospective cohort study of 23 PCUs in Japan was conducted from January 2017 to June 2018. Palliative care specialist physicians recorded whether patients experienced falls, serious complications from falls, activities that led to falls, independence (workability in the last days and use of indwelling urinary catheter), and Good Death Scale. ResultsOf the 1,633 patients evaluated, 9.2% (95% Confidence interval [95% CI 7.8 to 11]) experienced falls within 30 days prior to death. The patients who fell were mostly men, had eastern cooperative oncology group performance status 3 on admission, a longer estimated prognosis on admission, and delirium during hospitalization. Serious falls causing fractures or intracranial hemorrhages were rare (0.3% [95% CI 0.038 to 0.57]). The most common reason for falls was the need to use the toilet. The Good Death Scale and indwelling urinary catheter use were not significantly associated with falls. ConclusionFalls occur in approximately 10% of patients in PCUs, but serious complications are rare. The relationship between falls, independence, and quality of dying is complex; that is, a fall may not be necessarily bad, if it is the result of respect for the patients independence. Healthcare providers need to consider fall prevention while supporting patients desire to move on their own to maintain independence. WHAT IS ALREADY KNOWN ON THIS TOPICO_LIFalls are a major healthcare concern because of their potential to cause physical harm, emotional distress, and increased healthcare costs. C_LIO_LIAlthough many studies have investigated falls in acute care settings and the elderly population, there is a lack of literature specifically focusing on falls in the unique context of palliative care units. C_LI WHAT THIS STUDY ADDSO_LIFalls occur in only approximately 10% of patients, and only five cases (0.3%) of serious events were due to falls in palliative care units (PCUs). C_LIO_LIIndependence and quality of dying are not significantly compromised by falls. C_LI HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICYO_LIAlthough fall prevention is considered a priority, healthcare providers should support patients desires to move on their own to maintain independence. C_LIO_LIIt may be possible to maintain independence and quality of dying even for patients who have fallen. C_LI