Ko Eunjeong, Lee Jaehoon, Hong Youngjoon
School of Social Work, San Diego State University, San Diego, California, USA.
Institute for Measurement, Methodology, Analysis and Policy, Texas Tech University, Lubbock, Texas, USA.
Health Soc Care Community. 2016 Nov;24(6):708-716. doi: 10.1111/hsc.12248. Epub 2015 May 4.
This study explored low-income older adults' willingness to (i) complete advance directives, legal documents, whereby an individual designates decision-makers in the event that they cannot make their own decisions about end-of-life treatment preferences, and (ii) the role of social support and other predictors that impact their willingness. This study was conducted as part of a larger study exploring behaviours of advance care planning among low-income older adults. Out of a total of 255 participants from the original study, this study included 204 participants who did not complete an advance directive for data analysis. A cross-sectional study using probability random sampling stratified by ethnicity was used. Older adults residing in two supportive housing facilities or who were members of a senior centre in San Diego, California, USA, were interviewed in person between December 2010 and April 2011. Hierarchical logistic regression analysis revealed that the majority of participants (72.1%) were willing to complete advance directives and the factors significantly predicting willingness to complete included self-rated health, attitudes towards advance decision-making and social support. Participants with a poorer health status (OR = 1.43, 95% CI = 1.07-1.90) were more willing to complete advance directives. Conversely, participants with higher positive attitudes (OR = 1.18, 95% CI = 1.00-1.39) and greater social support (OR = 1.07, 95% CI = 1.00-1.15) were also more willing to complete advance directives. The findings suggest the importance of ongoing support from healthcare professionals in end-of-life care planning. Healthcare professionals can be a source of support assisting older adults in planning end-of-life care. Initiating ongoing communication regarding personal value and preference for end-of-life care, providing relevant information and evaluating willingness to complete as well as assisting in the actual completion of advance directives will be necessary.
本研究探讨了低收入老年人（i）完成预先指示（一种法律文件，即个人指定在无法就临终治疗偏好自行做决定时的决策者）的意愿，以及（ii）社会支持和其他影响其意愿的预测因素的作用。本研究是一项更大规模研究的一部分，该大规模研究旨在探索低收入老年人的预先护理计划行为。在原研究的255名参与者中，本研究纳入了204名未完成预先指示的参与者进行数据分析。采用了按种族分层的概率随机抽样的横断面研究方法。2010年12月至2011年4月期间，对居住在美国加利福尼亚州圣地亚哥市两个支持性住房设施中的老年人或老年中心成员进行了面对面访谈。分层逻辑回归分析显示，大多数参与者（72.1%）愿意完成预先指示，显著预测完成意愿的因素包括自评健康状况、对预先决策的态度和社会支持。健康状况较差的参与者（OR = 1.43，95%CI = 1.07 - 1.90）更愿意完成预先指示。相反，态度更积极的参与者（OR = 1.18，95%CI = 1.00 - 1.39）和社会支持更高的参与者（OR = 1.07，95%CI = 1.00 - 1.15）也更愿意完成预先指示。研究结果表明了医疗保健专业人员在临终护理计划中持续提供支持的重要性。医疗保健专业人员可以成为协助老年人规划临终护理的支持来源。就个人对临终护理的价值观和偏好发起持续沟通、提供相关信息、评估完成意愿以及协助实际完成预先指示将是必要的。
