High D M
Department of Philosophy, University of Kentucky, Lexington 40506.
J Aging Health. 1993 Nov;5(4):497-515. doi: 10.1177/089826439300500405.
Although advance directives for health care are widely advocated, usage rates among the elderly are low. Reported is a study testing comparative educational strategies to increase the use of advance directives among elderly persons ages 65 to 93. Follow-up interviews (n = 293) with intervention participants and controls showed that only 1 of 6 different strategies increased use. Neither lack of information nor simple procrastination were found as primary barriers to completion of advance directives. Most intervention participants preferred to defer to family surrogates and avoid executing advance directives. Level of education was a factor in use. Proposed is a restructuring of the advance directives process to accommodate elderly persons' wishes to authorize family members for surrogate health decision making, a policy that would assist the majority of people, including those who either wish to avoid or fail to execute advance directives.
尽管医疗保健预先指示得到广泛提倡，但老年人中的使用率却很低。本文报告了一项研究，该研究测试了比较教育策略，以提高65至93岁老年人对预先指示的使用。对干预参与者和对照组进行的随访访谈（n = 293）显示，6种不同策略中只有1种能提高使用率。未发现缺乏信息或单纯拖延是完成预先指示的主要障碍。大多数干预参与者更愿意听从家庭代理人的意见，而不愿签署预先指示。教育水平是一个使用因素。建议对预先指示流程进行重组，以满足老年人授权家庭成员做出替代医疗决策的意愿，这一政策将帮助大多数人，包括那些希望避免或未能签署预先指示的人。
