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日本居家老年人的预立医疗照护计划内容:一项定性研究。

Content of advance care planning among Japanese elderly people living at home: A qualitative study.

作者信息

Hirakawa Yoshihisa, Chiang Chifa, Hilawe Esayas Haregot, Aoyama Atsuko

机构信息

Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Japan.

Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Japan.

出版信息

Arch Gerontol Geriatr. 2017 May-Jun;70:162-168. doi: 10.1016/j.archger.2017.01.007. Epub 2017 Jan 31.

Abstract

PURPOSE OF STUDY

Elderly peoples' values and preferences for end-of-life care have not yet known in details. The aim of the present study was to investigate the end-of-life wishes and decision making among Japanese elderly people who required home care services. The study was designed to qualitative research strategies, using face to face interview data recorded in nursing care records, with a focus on advance care planning.

DESIGN AND METHODS

A total of 102 elderly people (47 males, 55 females) of 6 home care support offices in Hyogo prefecture participated.

RESULTS AND IMPLICATIONS

We finally extracted the following 5 themes: anxiety about the future, abandonment of control, clinging to current daily life, precarious mutual support, delegating decision-making. While elderly people living at home generally feel anxious and fearful about the future, they seemed to try to avoid thinking too seriously about possible complications in their life. They also tend to leave end-of-life decision to someone else, and their decisions tend to change as they advance in age and as their condition deteriorates. Our findings suggest that medical professionals and care managers always support their patients' decisions, allowing for the views of the informal caregivers on whom elderly people rely for decision-making.

摘要

研究目的

老年人对临终关怀的价值观和偏好尚未完全明确。本研究的目的是调查需要居家护理服务的日本老年人的临终意愿和决策情况。该研究采用定性研究策略,利用护理记录中记录的面对面访谈数据,重点关注预先护理计划。

设计与方法

兵库县6个居家护理支持办公室的102名老年人(47名男性,55名女性)参与了研究。

结果与启示

我们最终提炼出以下5个主题:对未来的焦虑、放弃控制权、执着于当前日常生活、不稳定的相互支持、委托决策。虽然居家老年人普遍对未来感到焦虑和恐惧,但他们似乎试图避免过于认真地思考生活中可能出现的并发症。他们也倾向于将临终决策留给他人,并且随着年龄增长和病情恶化,他们的决策往往会发生变化。我们的研究结果表明,医疗专业人员和护理管理人员应始终支持患者的决策,同时考虑老年人在决策时所依赖的非正式护理人员的意见。

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