Factors Associated with Quality of Life at the Last Month of Life in the United States

Yıl 2025, Cilt: 14 Sayı: 1, 119 - 137

Hazal Swearinger

https://doi.org/10.15869/itobiad.1517005

Öz

Recently, increasing aging rates and prolonged dying processes have significantly influenced the quality of life during the end-of-life period. The concept of quality of life at this stage has become a topic of growing debate, with a particular focus on alleviating symptoms and preserving functionality. This study aims to evaluate the quality of life among adults aged 65 and older in their last month of life in the United States and to identify associated risk factors. Utilizing data from the National Health and Aging Trends Study (NHATS), covering the period from 2011 to 2021 across ten waves, the analysis included 1,722 participants. Weighted prevalence estimates and multivariable regression models were employed. The results indicated that participants had an average quality of life score of 2.10 out of 5. Among the participants, 57.35% were conscious, and 42.36% were able to get out of bed without assistance. Additionally, 26.62% reported no pain, 40.61% did not experience respiratory issues, and 43.84% did not report feelings of sadness or anxiety. The study identified several risk factors associated with lower quality of life at the end of life, including race/ethnicity, living alone, multiple chronic conditions, and limitations in daily activities. These findings highlight critical implications for social policy and social work. Specifically, they underscore the importance of end-of-life care that not only extends life but also enhances the experience for patients and their families. Achieving this requires comprehensive support in personal care, socio-psychological assistance, and effective symptom management. The study further emphasizes the necessity of broader adoption of advance directives to align care with the priorities and preferences of patients and their families. Moreover, the use of evidence-based symptom assessment tools is essential for early detection and effective management of symptoms. Finally, the development of social work practices and policies tailored to socially disadvantaged and high-risk groups can play a pivotal role in mitigating challenges associated with end-of-life care, ultimately improving overall quality of life.

Anahtar Kelimeler

: Dying Process, Quality of Life, Symptom Management, Older Adults, Social Work, Social Policy

Amerika Birleşik Devletleri'nde Hayatın Son Ayında Yaşam Kalitesini Belirleyici Faktörlerin Analizi

Öz

Günümüzde artan yaşlanma oranları ve uzayan ölüm süreçleri, hayat sonu dönemdeki bireylerin yaşam kalitesi üzerinde önemli etkiler doğurmaktadır ve bu konu son yıllarda artan bir şekilde tartışılmaktadır. Hayat sonunda yaşam kalitesi, semptomların hafifliği ve işlevselliğin korunmasıyla ölçülmektedir. Bu çalışma, Amerika Birleşik Devletleri'nde 65 yaş üstü bireylerin hayatlarının son bir ayındaki yaşam kalitelerini değerlendirmeyi ve bu süreci etkileyen risk faktörlerini belirlemeyi amaçlamaktadır. Çalışmada, 2011-2021 yılları arasını kapsayan National Health and Aging Trends Study (NHATS) verilerinden elde edilen on etaplı örnekleme üzerinde yapılan analizde, 1,722 katılımcı incelenmiştir. Ağırlıklandırılmış prevalans ve ağırlıklandırılmış çok değişkenli regresyon modeli kullanılarak araştırma yürütülmüştür. Bulgularımıza göre, katılımcıların yaşam kalitesi skoru 5 üzerinden 2,10 olarak belirlenmiştir. Katılımcıların %57,35'inin bilinci açıkken, %42,36'sı yataktan desteksiz kalkabilmektedir. Ayrıca, %26,62'si ağrı/acı deneyimlememiş, %40,61'i solunum sorunu yaşamamış ve %43,84'ü üzüntü/kaygı hissetmemiştir. Hayat sonunda düşük yaşam kalitesi ile ilişkilendirilen risk faktörleri arasında ırk/etnisite, yalnız yaşamak, birden fazla kronik hastalığa sahip olmak ve günlük aktivitelerde kısıtlılık bulunmaktadır. Bu bulgular, önemli sosyal politika ve sosyal hizmet önerileri sunmaktadır. Özellikle hayat sonu bakımın sadece süreyi uzatmaktan öte, hastaların ve ailelerinin bu süreci nasıl deneyimlediğine odaklanması gerektiğini vurgulamaktadır. Bu süreçte bütüncül bakış açısı ile kişisel bakım, sosyo-psikolojik destek ve etkili semptom yönetimi konularında destek sağlanmalıdır. Hastaların ve ailelerinin önceliklerinin ve isteklerinin uygulanabilmesi için ileri direktiflerin daha yaygın bir şekilde kullanılması önem arz etmektedir. Ayrıca, semptomların tespiti konusunda kanıta dayalı semptom değerlendirme ölçeklerinin kullanımı yaygınlaştırılmalıdır. Son olarak, düşük yaşam kalitesine yönelik risk faktörleri göz önünde bulundurularak, sosyal olarak dezavantajlı yüksek risk gruplarına yönelik sosyal hizmet uygulamaları ve sosyal politikalar geliştirilerek, hayat sonu bakımında karşılaşılan zorlukların azaltılması ve yaşam kalitesinin artırılmasına önemli katkı sağlanabilir.

Anahtar Kelimeler

Ölüm Süreci, Yaşam Kalitesi, Semptom Yönetimi, Yaşlılık, Sosyal Hizmet, Sosyal Politika

Etik Beyan

Bu çalışma Etik Kurul Onayı Gerektirmemektedir.

Kaynakça

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