Kossman Debra A
J Gerontol Nurs. 2014 Jul;40(7):44-50. doi: 10.3928/00989134-20140310-01. Epub 2014 Mar 18.
This article reviews the literature on advance directives among U.S. older adults published from 2008 through 2013, with a focus on advance directive prevalence, implications of advance directives on patient care, and impact of interventions to increase advance directive completion. Advance directive completion varies by demographic characteristics and is affected by patient attitudes toward advance directives and end-of-life care. Patients with advance directives are less likely to receive feeding tubes, experience burdensome transitions between nursing homes and hospitals, and die in the hospital. Advance directive completion increases when health care providers ask culturally sensitive questions and educate patients about advance directives, but better documentation and communication of advance directives are needed to ensure adherence to these measures. Despite increasing advance directive completion as patients move from community to nursing homes to hospice, advance directives are often insufficiently detailed and current for health care professionals to be confident they are acting in accordance with what patients would choose for themselves.
本文回顾了2008年至2013年期间发表的关于美国老年人预立医疗指示的文献，重点关注预立医疗指示的普及率、预立医疗指示对患者护理的影响以及提高预立医疗指示完成率的干预措施的影响。预立医疗指示的完成情况因人口统计学特征而异，并受患者对预立医疗指示和临终护理态度的影响。有预立医疗指示的患者接受鼻饲管的可能性较小，在疗养院和医院之间经历繁琐的转诊，且在医院死亡的可能性较小。当医疗服务提供者提出具有文化敏感性的问题并对患者进行预立医疗指示教育时，预立医疗指示的完成率会提高，但需要更好地记录和传达预立医疗指示，以确保遵守这些措施。尽管随着患者从社区转移到疗养院再到临终关怀机构，预立医疗指示的完成率有所增加，但预立医疗指示往往不够详细和及时，以至于医疗保健专业人员无法确信他们的行为符合患者自己的选择。
