Golden Adam G, Corvea Martha H, Dang Stuti, Llorente Maria, Silverman Michael A
Geriatric Research, Education, and Clinical Center, Miami VA Healthcare System, 1201 NW 16th Street, Miami, FL 33125, USA.
Am J Hosp Palliat Care. 2009 Feb-Mar;26(1):13-7. doi: 10.1177/1049909108324359. Epub 2008 Oct 8.
We studied the prevalence of specific barriers that prevent indigent homebound older adults from obtaining advance directives and tested the effectiveness of clinical reminders for lowering the number of clients without advance directives. Case managers interviewed 1569 clients to determine whether they had an advance directive. All 530 clients without advance directives were contacted 3 months later to determine if advance directives had been obtained. Clients who still did not have advance directives were asked to list 1 or more reasons they did not have advance directives. About 57.8% of the barriers identified may reflect reluctance on the part of clients to address their own mortality. Reminders by the case managers were ineffective at lowering the number of homebound older adults without advance directives. Further studies are needed to identify and design strategies for convincing this population of homebound elderly to establish advance directives.
我们研究了阻碍贫困居家老年人获得预先指示的特定障碍的发生率，并测试了临床提醒对于减少没有预先指示的客户数量的有效性。个案管理员采访了1569名客户，以确定他们是否有预先指示。3个月后，联系了所有530名没有预先指示的客户，以确定他们是否已获得预先指示。仍没有预先指示的客户被要求列出1个或更多他们没有预先指示的原因。所确定的约57.8%的障碍可能反映出客户自身不愿面对死亡。个案管理员的提醒在减少没有预先指示的居家老年人数量方面没有效果。需要进一步研究，以确定并设计策略来说服这群居家老年人制定预先指示。
