Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland.
Service of geriatric medicine and geriatric rehabilitation, Lausanne university hospital, Chemin de Mont Paisible 16, 1011, Lausanne, Switzerland.
BMC Geriatr. 2019 Apr 24;19(1):118. doi: 10.1186/s12877-019-1113-3.
Legal dispositions for advance care planning (ACP) are available but used by a minority of older adults in Switzerland. Some studies found that knowledge of and perception of those dispositions are positively associated with their higher usage. The objective of the present study is to test the hypothesis of an association between increased knowledge of ACP dispositions and a more positive perception of them.
Data collected in 2014 among 2125 Swiss community-dwellers aged 71 to 80 of the Lausanne cohort 65+ (Lc65+), a population-based longitudinal study on aging and frailty. Data collection was conducted through a questionnaire on knowledge, use and perception of lasting power of attorney, advance directives and designation of a health care proxy. Covariables were extracted from the Lc65+ database. Bivariable and multivariable regression analyses assessed the association between level of knowledge and perception.
Half the participants did not know about legal dispositions for ACP; filing rates were 14% for advance directives, 11% for health care proxy and 6% for lasting power of attorney. Level of knowledge about the dispositions was associated with a more positive perception of them, even when adjusting for confounding factors.
Although the direction of the association's causality needs more investigation, results indicate that better knowledge on ACP dispositions could improve the perception older people have of them. Communication on dispositions should take into account individual knowledge levels and address commonly enunciated barriers that seem to diminish with increased knowledge.
瑞士为预先医疗护理计划（ACP）提供了法律规定，但只有少数老年人会使用这些规定。一些研究发现，对这些规定的了解和看法与它们的使用频率呈正相关。本研究的目的是检验以下假设，即对 ACP 规定的了解程度增加与对它们的看法更加积极之间存在关联。
2014 年，洛桑 65+队列（Lc65+）对 2125 名年龄在 71 至 80 岁的瑞士社区居民进行了一项基于人口的老龄化和脆弱性纵向研究，收集了他们对持久授权书、预先指示和指定医疗代理人的了解、使用和看法的数据。数据收集通过一份关于知识、使用和对持久授权书、预先指示和指定医疗代理人的看法的调查问卷进行。协变量从 Lc65+数据库中提取。单变量和多变量回归分析评估了知识水平与看法之间的关联。
一半的参与者不知道 ACP 的法律规定；预先指示的归档率为 14%，医疗代理的归档率为 11%，持久授权书的归档率为 6%。对这些规定的了解程度与对它们的看法更积极有关，即使在调整了混杂因素后也是如此。
尽管关联因果关系的方向需要更多的研究，但结果表明，更好地了解 ACP 规定可以改善老年人对它们的看法。关于规定的沟通应该考虑到个人的知识水平，并解决通常会降低的、与知识增加相关的障碍。
