Glass Anne P, Nahapetyan Lusine
Institute of Gerontology, College of Public Health, University of Georgia Institute of Gerontology, 255 East Hancock Ave., Athens, GA 30602, USA.
Prev Chronic Dis. 2008 Jan;5(1):A08. Epub 2007 Dec 15.
In the United States, 73% of deaths occur among people aged 65 years or older. Although most would prefer to die at home after a short illness, most actually die in institutions after prolonged declines. Despite this discrepancy, elders and their adult children often do not discuss end-of-life preferences. Use of advance directives has not been widespread, and people often avoid the subject until a crisis. This project focused on informal family communication about end-of-life preparation and preferences, about which little is known.
In May 2006, we conducted in-depth exploratory interviews with 15 older adults about their end-of-life preparation and preferences and with 15 younger adults about their parents' end-of-life preparation and preferences. The interview included an item rating the depth of discussion.
Participants in both groups were primarily female and white. Mean age of older adults was 78.6 years (range, 70-88 years). Mean age of younger adults was 53.1 years (range, 42-63 years); mean age of their parents was 82.6 years (range, 68-99 years). Nine older adults reported discussing end-of-life preparation and preferences with their adult children; six had barely discussed the topic at all. Ten younger adults reported having talked with their parents about end-of-life preparation and preferences; five had not discussed it. Barriers to discussions about end-of-life preparation and preferences were fear of death, trust in others to make decisions, family dynamics, and uncertainty about preferences. Facilitators for discussion were acceptance of the reality of death, prior experience with death, religion or spirituality, and a desire to help the family. Successful strategies included casually approaching the topic and writing down end-of-life preparation and preferences.
Knowing the obstacles to and facilitators for discussion can help health care and public health professionals target approaches to encouraging elders and their families to discuss end-of-life preparation and preferences before a crisis.
在美国，73%的死亡发生在65岁及以上的人群中。尽管大多数人希望在短暂患病后在家中离世，但实际上大多数人在长期身体衰退后在医疗机构中死亡。尽管存在这种差异，但老年人及其成年子女往往不讨论临终偏好。预先指示的使用并不广泛，人们通常会避免谈论这个话题，直到危机出现。本项目聚焦于关于临终准备和偏好的非正式家庭沟通，对此人们了解甚少。
2006年5月，我们对15名老年人进行了关于他们的临终准备和偏好的深入探索性访谈，并对15名年轻人进行了关于他们父母的临终准备和偏好的深入探索性访谈。访谈包括一项对讨论深度进行评分的项目。
两组参与者主要为女性和白人。老年人的平均年龄为78.6岁（范围为70 - 88岁）。年轻人的平均年龄为53.1岁（范围为42 - 63岁）；他们父母的平均年龄为82.6岁（范围为68 - 99岁）。9名老年人报告与他们的成年子女讨论过临终准备和偏好；6名老年人几乎完全没有讨论过这个话题。10名年轻人报告与他们的父母谈论过临终准备和偏好；5名年轻人没有讨论过。关于临终准备和偏好讨论的障碍包括对死亡的恐惧、信任他人做决定、家庭动态以及偏好的不确定性。讨论的促进因素包括接受死亡的现实、先前的死亡经历、宗教或精神信仰以及帮助家人的愿望。成功的策略包括不经意地提及这个话题以及写下临终准备和偏好。
了解讨论的障碍和促进因素可以帮助医疗保健和公共卫生专业人员确定方法，以鼓励老年人及其家人在危机发生前讨论临终准备和偏好。
