Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
St Christopher's Hospice, London, UK.
Palliat Med. 2021 Jun;35(6):1137-1147. doi: 10.1177/02692163211013260. Epub 2021 May 3.
The population of frail elders is growing, and due to their vulnerability to sudden deterioration, advance care planning is particularly important. However, advance care planning is uncommon for multiple reasons, some of which are linked to the perceptions of frail elders and their families.
To explore the barriers and enablers to advance care planning engagement with frail elders.
Qualitative in-depth interviews with thematic analysis.
SETTING/PARTICIPANTS: Purposive sample of 10 frail elders and 8 nominated family members using a community-based older persons' service run by a large urban UK hospice. Frail elders had capacity, were ⩾65 (median 85, range 71-95), scored 6 or 7 (median 6.5) on the Clinical Frailty Scale, and 70% were female.
Key barriers were: , in terms of meaning and the language used; , with frail elders preferring to focus on living well now; and the , and the influence of relationship on end of life decision-making. Engagement strategies included preparing the frail elder for advance care planning conversations and using a gentle, honest, individualised approach.
Essential enablers for frail elders are understanding what advance care planning is and why it may be relevant to them. For professionals, enablers include recognising the importance of living well now and relational decision-making. To further support advance care planning, recommendations include early engagement and re-conceptualising advance care planning as an ongoing process which encompasses current and future care. Further research is needed in different cultures and care contexts.
虚弱老年人的数量在增加，由于他们容易突然恶化，因此预先护理计划尤为重要。然而，出于多种原因，预先护理计划并不常见，其中一些原因与虚弱老年人及其家属的看法有关。
探讨与虚弱老年人进行预先护理计划的障碍和促进因素。
采用定性深入访谈和主题分析。
地点/参与者：来自英国一家大型城市临终关怀机构运营的社区老年人服务机构的 10 名虚弱老年人和 8 名指定家庭成员，采用了目的性抽样。虚弱老年人有能力，年龄 ⩾65 岁（中位数 85 岁，范围 71-95 岁），临床虚弱量表评分为 6 或 7 分（中位数 6.5 分），70%为女性。
主要障碍包括：虚弱老年人对预先护理计划的意义和使用的语言理解有限；关注当下，喜欢现在就过好生活；以及关系的影响，以及关系对临终决策的影响。参与策略包括为虚弱老年人准备预先护理计划对话，并采用温和、诚实、个性化的方法。
虚弱老年人的重要促进因素是理解预先护理计划是什么以及为什么它可能与他们相关。对于专业人员来说，促进因素包括认识到现在过好生活和关系决策的重要性。为了进一步支持预先护理计划，建议包括早期参与和重新概念化预先护理计划，将其视为一个涵盖当前和未来护理的持续过程。需要在不同的文化和护理环境中进行进一步的研究。
