在美国，死在家中的人比死在医院的人还多

在美国，死在家中的人比死在医院的人还多

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.

《新英格兰医学杂志》周三发表的一份报告显示，自20世纪初以来，美国死于家中的人首次超过了死于医院的人。

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.

研究人员根据美国疾病预防控制中心和国家健康统计中心收集的数据，分析了美国自然死亡的人数。

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.

他们将自然死亡定义为一种由疾病直接导致的死亡，即人们死于心脏病或癌症等疾病，而不是死于车祸等。作者研究了2003年至2017年的数据。

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.

他们发现，医院死亡仍然很普遍，但这个数字正在下降。2003年，医院死亡人数为90.5874万人，占总死亡人数的39.7%;截至2017年，医院死亡人数为764,424人，占总死亡人数的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，家庭死亡人数从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.

临终关怀机构的死亡人数也有所增加。在临终关怀中心，一个跨学科的专业团队专门研究临终关怀。他们的工作是帮助管理疼痛和人的身体需求，以及他们的精神和精神上的痛苦。临终关怀也帮助家庭和协调护理。

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

2003年，5395人(2%)死于临终关怀，2017年，这一数字上升到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%).

疗养院的死亡人数也有所下降。2003年，有538817人(23.6%)死亡。2017年为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.

报告称，癌症患者在家中或临终关怀中心死亡的几率最大。痴呆症患者更多地死在养老院，而中风患者在家中死亡的几率最低。

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.

虽然越来越多的人使用临终关怀，但其他研究表明，这种关怀没有得到充分利用。早期的研究发现，医疗保险覆盖了长达6个月的临终关怀，然而，大多数人只在临终关怀的几天，而不是在死亡前的几个月。

Deciding where to die

决定在哪里死亡

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，大多数人更愿意死在家里，对这种经历感到更平静。

"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.

研究临终决策的布法罗大学社会工作学院社会工作教授黛博拉·瓦尔德拉说，“我再怎么强调进行这些对话的意义都不为过，不仅要强调你在疾病的后期需要什么样的护理，还要强调这个人对自己想去哪里的想法。” 瓦尔德拉没有参与这项新的研究。

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

她说，这份报告很重要，因为人们通常要等很长时间才能进行这些对话。

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，重要的是照顾者也有同样的感受。即使有临终关怀的帮助，照顾垂死的人在身体上和精神上都是困难的，而且“并不是所有的死亡都是美好的，” 瓦尔德拉补充说。

"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.

“在这个国家，我们把在家中死亡的概念浪漫化了。这并不是说这对家人和他们照顾的人来说不好，但我们通常认为这是一个充满爱的时刻，人们唱歌、牵手、祈祷，而实际上这是一个非常艰难的工作。” 瓦尔德拉说。

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?

她说，注意一些小事情也很重要，比如决定一个人在家里的什么地方会死去。例如，如果你把餐桌清理干净，放到病床上，那么下一个感恩节会发生什么呢?

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

“人们可以克服它，但记忆不会消失，” 瓦尔德拉说。