North Shore Long Island Jewish Health System, New Hyde Park, New York 11040, USA.
Palliat Support Care. 2010 Sep;8(3):267-75. doi: 10.1017/S1478951510000064.
The purpose of this study was to determine the factors which influence advance directive (AD) completion among older adults.
Direct interviews of hospitalized and community-dwelling cognitively intact patients > 65 years of age were conducted in three tertiary teaching settings in New York. Analysis of AD completion focused on its correlation with demographics, personal beliefs, knowledge, attitudes, and exposure to educational media initiatives. We identified five variables with loadings of at least 0.30 in absolute value, along with five demographic variables (significant in the univariate analyses) for multiple logistic regression. The backward elimination method was used to select the final set of jointly significant predictor variables.
Of the 200 subjects consenting to an interview, 125 subjects (63%) had completed ADs. In comparing groups with and without ADs, gender (p < 0.0002), age (p < 0.0161), race (p < 0.0001), education (p < 0.0039), and religion (p < 0.0104) were significantly associated with having an AD. Factors predicting AD completion are: thinking an AD will help in the relief of suffering at the end of life, (OR 76.3, p < 0.0001), being asked to complete ADs/ or receiving explanation about ADs (OR 55.2, p < 0.0001), having undergone major surgery (OR 6.3, p < 0.0017), female gender (OR 11.1, p < 0.0001) and increasing age (76-85 vs. 59-75: OR 3.4, p < 0.0543; < 85 vs. 59-75: OR 6.3, p < 0.0263).
This study suggests that among older adults, the probability of completing ADs is related to personal requests by health care providers, educational level, and exposure to advance care planning media campaigns.
本研究旨在确定影响老年人预先指示（AD）完成的因素。
在纽约的三个三级教学环境中，对住院和社区居住的认知功能正常的 > 65 岁患者进行直接访谈。对 AD 完成情况的分析侧重于其与人口统计学、个人信仰、知识、态度以及对教育媒体倡议的接触的相关性。我们确定了五个绝对值大于等于 0.30 的变量，以及五个在单变量分析中具有显著意义的人口统计学变量（用于多元逻辑回归）。使用向后消除法选择最终的联合显著预测变量集。
在 200 名同意接受访谈的受试者中，有 125 名（63%）完成了 AD。在比较有 AD 和没有 AD 的组时，性别（p < 0.0002）、年龄（p < 0.0161）、种族（p < 0.0001）、教育（p < 0.0039）和宗教（p < 0.0104）与拥有 AD 显著相关。预测 AD 完成的因素是：认为 AD 将有助于缓解生命末期的痛苦（OR 76.3，p < 0.0001）、被要求完成 AD/或接受有关 AD 的解释（OR 55.2，p < 0.0001）、接受过重大手术（OR 6.3，p < 0.0017）、女性（OR 11.1，p < 0.0001）和年龄增长（76-85 岁与 59-75 岁：OR 3.4，p < 0.0543；< 85 岁与 59-75 岁：OR 6.3，p < 0.0263）。
本研究表明，在老年人中，完成 AD 的概率与医疗保健提供者的个人请求、教育水平和接触预先护理计划媒体活动有关。
