在美國(guó)，死在家中的人比死在醫(yī)院的人還多

在美國(guó)，死在家中的人比死在醫(yī)院的人還多

For the first time since the early 20th century, more people in the United States are dying at home than at the hospital, according to a report published in the New England Journal of Medicine on Wednesday.

《新英格蘭醫(yī)學(xué)雜志》周三發(fā)表的一份報(bào)告顯示，自20世紀(jì)初以來(lái)，美國(guó)死于家中的人首次超過(guò)了死于醫(yī)院的人。

The researchers looked at the number of natural deaths in the United States based on data collected by the US Centers for Disease Control and Prevention and the National Center for Health Statistics.

研究人員根據(jù)美國(guó)疾病預(yù)防控制中心和國(guó)家健康統(tǒng)計(jì)中心收集的數(shù)據(jù)，分析了美國(guó)自然死亡的人數(shù)。

They define natural deaths as when a medical condition leads directly to death, meaning people died from heart problems or cancer, among other diseases, rather than dying in a car accident, for example. The authors looked at data from 2003 to 2017.

他們將自然死亡定義為一種由疾病直接導(dǎo)致的死亡，即人們死于心臟病或癌癥等疾病，而不是死于車禍等。作者研究了2003年至2017年的數(shù)據(jù)。

They found that hospital deaths are still common, but that number is declining. There were 905,874 hospital deaths in 2003 -- 39.7% of deaths -- and by 2017 there were 764,424 hospital deaths, 29.8% of deaths.

他們發(fā)現(xiàn)，醫(yī)院死亡仍然很普遍，但這個(gè)數(shù)字正在下降。2003年，醫(yī)院死亡人數(shù)為90.5874萬(wàn)人，占總死亡人數(shù)的39.7%;截至2017年，醫(yī)院死亡人數(shù)為764,424人，占總死亡人數(shù)的29.8%。

The number of deaths at home, though, increased from 543,874 (23.8%) in 2003 to 788,757 (30.7%) in 2017.

然而，家庭死亡人數(shù)從2003年的543,874人(23.8%)增加到2017年的788,757人(30.7%)。

There was also an increase in the number of people dying in hospice facilities. In hospice, an interdisciplinary team of professionals that specialize in end-of life-care address the whole person. They work to help manage pain and the person's physical needs, as well as their mental and spiritual distress. Hospice also helps the family and coordinates care.

臨終關(guān)懷機(jī)構(gòu)的死亡人數(shù)也有所增加。在臨終關(guān)懷中心，一個(gè)跨學(xué)科的專業(yè)團(tuán)隊(duì)專門研究臨終關(guān)懷。他們的工作是幫助管理疼痛和人的身體需求，以及他們的精神和精神上的痛苦。臨終關(guān)懷也幫助家庭和協(xié)調(diào)護(hù)理。

In 2003, 5,395 (.2%) died in hospice, in 2017, the number rose to 212,652 (8.3%).

2003年，5395人(2%)死于臨終關(guān)懷，2017年，這一數(shù)字上升到212652人(8.3%)。

The number of deaths at nursing homes also declined. In 2003, there were 538,817 (23.6%) deaths. In 2017, there were 534,714 (20.8%).

療養(yǎng)院的死亡人數(shù)也有所下降。2003年，有538817人(23.6%)死亡。2017年為534714人(20.8%)。

Patients with cancer had the greatest odds of dying at home or in hospice, the report said. People with dementia died more often at a nursing home, and stroke patients had the lowest odds of dying at home.

報(bào)告稱，癌癥患者在家中或臨終關(guān)懷中心死亡的幾率最大。癡呆癥患者更多地死在養(yǎng)老院，而中風(fēng)患者在家中死亡的幾率最低。

While an increasing number of people use hospice, other studies have shown that kind of care is underutilized. Medicare covers up to six months of hospice care, yet, most people only turn to hospice days, instead of months, before death, earlier studies found.

雖然越來(lái)越多的人使用臨終關(guān)懷，但其他研究表明，這種關(guān)懷沒(méi)有得到充分利用。早期的研究發(fā)現(xiàn)，醫(yī)療保險(xiǎn)覆蓋了長(zhǎng)達(dá)6個(gè)月的臨終關(guān)懷，然而，大多數(shù)人只在臨終關(guān)懷的幾天，而不是在死亡前的幾個(gè)月。

Deciding where to die

決定在哪里死亡

Previous studies have shown that the majority of people would prefer to die at home and feel more at peace with the experience.

之前的研究表明，大多數(shù)人更愿意死在家里，對(duì)這種經(jīng)歷感到更平靜。

"I cannot emphasize enough the point of having these conversations, not just what kind of care you want in later stages of an illness, but also what the person's thoughts are about where they want to be," said Deborah Waldrop, a professor of social work at the University at Buffalo School of Social Work who studies end-of-life decision-making. Waldrop did not work on the new study.

研究臨終決策的布法羅大學(xué)社會(huì)工作學(xué)院社會(huì)工作教授黛博拉·瓦爾德拉說(shuō)，“我再怎么強(qiáng)調(diào)進(jìn)行這些對(duì)話的意義都不為過(guò)，不僅要強(qiáng)調(diào)你在疾病的后期需要什么樣的護(hù)理，還要強(qiáng)調(diào)這個(gè)人對(duì)自己想去哪里的想法。” 瓦爾德拉沒(méi)有參與這項(xiàng)新的研究。

She said this report is important because people often wait too long to have these conversations.

她說(shuō)，這份報(bào)告很重要，因?yàn)槿藗兺ǔＲ群荛L(zhǎng)時(shí)間才能進(jìn)行這些對(duì)話。

If someone wants to die at home, it's important that a caregiver feels the same way. Caring for the dying, even with hospice help, is physically and mentally difficult and not "all deaths are pretty," Waldrop added.

如果有人想死在家里，重要的是照顧者也有同樣的感受。即使有臨終關(guān)懷的幫助，照顧垂死的人在身體上和精神上都是困難的，而且“并不是所有的死亡都是美好的，” 瓦爾德拉補(bǔ)充說(shuō)。

"In this country, we have romanticized the notion of death at home. That is not to say it can't be wonderful for the family and for the person they are caring for, but we often think about this as a loving time where people are singing and holding hands and praying, when in reality it is a very hard job," Waldrop said.

“在這個(gè)國(guó)家，我們把在家中死亡的概念浪漫化了。這并不是說(shuō)這對(duì)家人和他們照顧的人來(lái)說(shuō)不好，但我們通常認(rèn)為這是一個(gè)充滿愛(ài)的時(shí)刻，人們唱歌、牽手、祈禱，而實(shí)際上這是一個(gè)非常艱難的工作。” 瓦爾德拉說(shuō)。

It's also important to be mindful of little things, she said, like deciding where in the home someone will die. If you clear out the dining room table for the hospital bed, for example, what happens next Thanksgiving?

她說(shuō)，注意一些小事情也很重要，比如決定一個(gè)人在家里的什么地方會(huì)死去。例如，如果你把餐桌清理干凈，放到病床上，那么下一個(gè)感恩節(jié)會(huì)發(fā)生什么呢?

"People can work through it, but that memory doesn't go away," Waldrop said.

“人們可以克服它，但記憶不會(huì)消失，” 瓦爾德拉說(shuō)。