一末期失智個案之居家安寧照護經驗

The Experience of Home-based Palliative Care for a Patient with Advanced Dementia

10.3966/168232812018032801006

謝惠婷(Hui-Ting Hsieh)；林儀蒂(Yi-Di Lin)；黃伯瑜(Po-Yu Huang)；邱榮鵬(Jung-Peng Chiu)；黃建榮(Chien-Jung Huang)；許中華(Chung-Hua Hsu)

末期失智症 ； 預立醫療諮商 ； 預立醫療決定 ； 居家整合醫療 ； advance care planning ； advance decision ； advanced dementia ； integrated home medical care

台灣家庭醫學雜誌

28卷1期（2018 / 03 / 01）

45 - 53

繁體中文

失智症的盛行率近年來隨著人口老化逐漸攀升，由於其漸漸失能的病程及不可治癒性，使得末期失智症的照護成為一重要之議題，若在不了解失智症的自然病程下給予很多不必要的醫療，反而增添患者與家屬的痛苦。臺灣於2009年9月1日起，已正式由中央健保局公告將老年期及初老期器質性精神病態納入安寧療護健保給付，推廣末期失智的安寧照護。本文藉由家庭醫師配合「全民健康保險居家醫療照護整合計畫」，照顧一位末期失智患者之經驗，不僅分享居家照護模式，也探討末期失智病人常面臨的兩個問題：營養與水分給予的方式及預立醫療決定。

As the population ages, the prevalence of dementia is rising worldwide. The role of palliative care in avoiding unwanted or unnecessary treatments is becoming increasingly important for advanced dementia as a non-cancer incurable life-limiting illness covered in Hospice Palliative Care Act since 2009. The article focuses on our experience of providing a 95-year-old women with advanced dementia with home-based palliative care based on the Integrated Home Medical Care Project. In presenting the experience, we not only share the home-based care model but also discuss two common palliative issues of advanced dementia: eating problems and advanced directives.

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