Gabriel Lutz, Yulin Yang, Yilin Zhang, Chixiang Chen, Raya Elfadel Kheirbek
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Through retrospective cohort analysis, we explored the association between incarceration history and EOL care, focusing on pain and symptom burden.</p><p><strong>Results: </strong>Analyses showed that individuals with a history of incarceration experienced significantly higher levels of pain (65% reported \"moderate\" or \"severe\" pain) compared to nonincarcerated individuals (50%; adjusted odds ratio = 1.45, 95% confidence interval [CI]: 1.22-1.71, p < .001). Additionally, the symptom burden index revealed that formerly incarcerated individuals had a higher average symptom score (2.8 vs 2.1; β = 0.7, 95% CI: 0.5-0.9, p < .001), indicating a greater range of symptoms in their final year of life. These disparities persisted after adjusting for demographic, health, and socioeconomic variables.</p><p><strong>Conclusions: </strong>This study reveals that a history of incarceration significantly affects EOL experiences, with formerly incarcerated individuals facing higher levels of pain and a greater symptom burden compared to nonincarcerated individuals. This underscores the need for tailored palliative care to address the unique needs of this vulnerable population. This research highlights a critical area for intervention and calls for healthcare systems to adapt their practices to better serve those with incarceration histories.</p>","PeriodicalId":94243,"journal":{"name":"The journals of gerontology. 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引用次数: 0
摘要
背景:监禁对健康的不利影响已得到充分证实,它影响着个人的整个生命历程。然而,监禁史对生命末期(EOL)经历的影响仍未得到探讨。本研究旨在探讨在临近生命终点时,曾经的监禁经历如何影响个人的经历和护理需求:利用 "健康与退休研究"(Health and Retirement Study),我们对 2012-2018 年间参与研究的 1710 人进行了二次分析。通过回顾性队列分析,我们探讨了监禁史与临终关怀之间的关联,重点关注疼痛和症状负担:分析表明,与未被监禁的人相比(50%;AOR = 1.45,95% CI:1.22-1.71,p < 0.001),有监禁史的人经历的疼痛程度明显更高(65% 的人报告有 "中度 "或 "重度 "疼痛)。此外,症状负担指数显示,曾被监禁者的平均症状得分更高(2.8 vs. 2.1; β = 0.7, 95% CI: 0.5-0.9, p < 0.001),这表明他们在生命最后一年的症状范围更大。在对人口、健康和社会经济变量进行调整后,这些差异依然存在:本研究揭示了监禁史对临终体验的重大影响,与未被监禁的人相比,曾被监禁的人面临更高水平的疼痛和更大的症状负担。这突出表明,有必要提供量身定制的姑息关怀,以满足这一弱势群体的独特需求。这项研究强调了一个需要干预的关键领域,并呼吁医疗保健系统调整其实践,以便更好地为有监禁史的人服务。
A Tale of 2 Experiences: Navigating End-of-Life Care With a History of Incarceration.
Background: The adverse health effects of incarceration are well-documented, affecting individuals throughout their life course. However, the influence of a history of incarceration on end-of-life (EOL) experiences remains unexplored. This study aims to examine how prior incarceration affects individuals' experiences and care needs as they approach the EOL.
Methods: Leveraging the Health and Retirement Study, we conducted secondary analyses on 1 710 individuals who participated between 2012 and 2018. Through retrospective cohort analysis, we explored the association between incarceration history and EOL care, focusing on pain and symptom burden.
Results: Analyses showed that individuals with a history of incarceration experienced significantly higher levels of pain (65% reported "moderate" or "severe" pain) compared to nonincarcerated individuals (50%; adjusted odds ratio = 1.45, 95% confidence interval [CI]: 1.22-1.71, p < .001). Additionally, the symptom burden index revealed that formerly incarcerated individuals had a higher average symptom score (2.8 vs 2.1; β = 0.7, 95% CI: 0.5-0.9, p < .001), indicating a greater range of symptoms in their final year of life. These disparities persisted after adjusting for demographic, health, and socioeconomic variables.
Conclusions: This study reveals that a history of incarceration significantly affects EOL experiences, with formerly incarcerated individuals facing higher levels of pain and a greater symptom burden compared to nonincarcerated individuals. This underscores the need for tailored palliative care to address the unique needs of this vulnerable population. This research highlights a critical area for intervention and calls for healthcare systems to adapt their practices to better serve those with incarceration histories.