Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
VA Connecticut Health System, West Haven, Connecticut, USA.
J Am Geriatr Soc. 2021 Jan;69(1):114-121. doi: 10.1111/jgs.16813. Epub 2020 Sep 8.
BACKGROUND/OBJECTIVES: Little is known about older adults who have intact capacity but do not have a desired surrogate to make decisions if their capacity becomes impaired.
Cross-sectional study of a nationally representative sample.
National Social Life, Health, and Aging Project (NSHAP), 2005-2006.
Community-dwelling older adults without known cognitive impairment, aged 57 to 85, interviewed as part of NSHAP (n = 2,767).
We examined demographic, medical, and social connectedness characteristics associated with answering "no" to this question: "Do you have someone who you would like to make medical decisions for you if you were unable, as for example if you were seriously injured or very sick?" Because many states permit nuclear family to make decisions for persons with no legally appointed health care agent, we used logistic regression to identify factors associated with individuals who were ill suited to this paradigm in the sense that they had nuclear family but did not have a desired surrogate.
Among NSHAP respondents, 7.5% (95% confidence interval = 6.4-8.7) did not have a desired surrogate. Nearly 90% of respondents without desired surrogates had nuclear family. Compared with respondents with desired surrogates, those without desired surrogates had lower indicators of social connectedness. On average, however, they had four confidants, approximately 70% socialized at least monthly, and more than 90% could discuss their health with a confidant. Among respondents who had nuclear family, few characteristics distinguished those with and without desired surrogates.
Nearly 8% of older adults did not have a desired surrogate. Most had nuclear family and were not socially disconnected. Older adults should be asked explicitly about a desired surrogate, and strategies are needed to identify surrogates for those who do not have family or would not choose family to make decisions for them.
背景/目的：对于那些能力完好但如果能力受损，没有想要的代理人来做出决策的老年人，我们知之甚少。
对具有全国代表性的样本进行的横断面研究。
国家社会生活、健康和老龄化项目（NSHAP），2005-2006 年。
没有认知障碍的、年龄在 57 至 85 岁之间的、作为 NSHAP 的一部分接受采访的社区居住的老年人（n=2767）。
我们检查了与回答这个问题“如果您无法做出医疗决策，例如如果您受到重伤或非常生病，您是否有您希望为您做出决策的人？”相关的人口统计学、医学和社会联系特征。因为许多州允许核心家庭为没有合法指定的医疗保健代理人的人做出决策，所以我们使用逻辑回归来确定与个人不适合这种模式的因素，因为他们有核心家庭但没有想要的代理人。
在 NSHAP 受访者中，有 7.5%（95%置信区间=6.4-8.7）没有想要的代理人。几乎 90%没有想要的代理人的受访者都有核心家庭。与有想要的代理人的受访者相比，没有想要的代理人的受访者的社会联系指标较低。然而，平均而言，他们有四个知己，大约 70%的人每月至少社交一次，超过 90%的人可以与知己讨论他们的健康问题。在有核心家庭的受访者中，很少有特征可以区分有和没有想要的代理人的受访者。
近 8%的老年人没有想要的代理人。大多数人都有核心家庭，并且没有与社会脱节。应该明确询问老年人关于他们想要的代理人的问题，并且需要制定策略来为那些没有家庭或不愿意选择家庭来为他们做出决策的人确定代理人。
