Parkinson and Other Movement Disorders Center, University of California San Diego, Department of Neurosciences, San Diego, CA, USA.
Clinical & Translation Research Institute, University of California San Diego, San Diego, CA, USA.
Parkinsonism Relat Disord. 2019 May;62:73-78. doi: 10.1016/j.parkreldis.2019.01.026. Epub 2019 Jan 30.
The utilization of advance directives in individuals with Parkinson's disease (PD) and atypical parkinsonian disorders (APD) and their caregivers requires further investigation. This study determined the utilization rates of four forms of advance directives: living will, durable power of attorney, durable power of attorney for healthcare, and medical orders in these individuals. We hypothesized that having a neurodegenerative parkinsonian disorder or exposure to these disorders would increase the likelihood of having advance directives.
50 PD participants, 49 APD participants, 50 caregivers and 50 non-caregiver controls were surveyed regarding advance directives.
The median number of advance directives was 1 in controls, 2 in caregivers and PD participants and 3 in APD participants. Patients with PD were 4.08 times more likely to have durable power of attorney (p < 0.001) and 2.08 times more likely to have durable power of attorney for healthcare (p = 0.011) than controls. Patients with APD were 1.66 times more likely to have a living will (p = 0.006), 4.81 times more likely to have a durable power of attorney (p < 0.001) and 2.47 times more likely to have a durable power of attorney for healthcare (p = 0.003) than controls. Caregivers were1.58 times more likely to have a living will (p = 0.012) and 2.21 times more likely to have a durable power of attorney for healthcare than controls.
Having or being exposed to parkinsonian disorders significantly increases the likelihood of utilizing advance directives. Additionally, exposure to a parkinsonian disorder as a caregiver increases advance directive use.
在帕金森病（PD）和非典型帕金森病（APD）患者及其照护者中，使用预先指示需要进一步研究。本研究确定了这两种患者中四种预先指示形式的使用比率：生前预嘱、持久授权书、医疗保健持久授权书和医疗指令。我们假设患有神经退行性帕金森病或接触这些疾病会增加拥有预先指示的可能性。
调查了 50 名 PD 参与者、49 名 APD 参与者、50 名照护者和 50 名非照护者对照者有关预先指示的情况。
对照组的预先指示中位数为 1，照护者和 PD 患者为 2，APD 患者为 3。与对照组相比，PD 患者更有可能拥有持久授权书（p<0.001）和医疗保健持久授权书（p=0.011），可能性分别为 4.08 倍和 2.08 倍。与对照组相比，APD 患者更有可能拥有生前预嘱（p=0.006）、持久授权书（p<0.001）和医疗保健持久授权书（p=0.003），可能性分别为 1.66 倍、4.81 倍和 2.47 倍。照护者更有可能拥有生前预嘱（p=0.012）和医疗保健持久授权书，可能性分别为 1.58 倍和 2.21 倍。
患有帕金森病或接触帕金森病会显著增加使用预先指示的可能性。此外，作为照护者接触帕金森病会增加预先指示的使用。
