老年养老院居民的生存意愿：瑞士的一项横断面研究。

Will to Live in Older Nursing Home Residents: A Cross-Sectional Study in Switzerland.

机构信息

Palliative and Supportive Care Service and Service of Geriatric Medicine and Geriatric Rehabilitation (M.-A.B., E.R.T., R.J.J.), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Service of Geriatric Medicine and Geriatric Rehabilitation (E.R.T.), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

出版信息

J Pain Symptom Manage. 2021 Nov;62(5):902-909. doi: 10.1016/j.jpainsymman.2021.05.006. Epub 2021 May 15.

DOI:10.1016/j.jpainsymman.2021.05.006

PMID:34000336

Abstract

CONTEXT

The will to live (WTL) is an important indicator of subjective well-being. It may enable a deeper understanding of the well-being of nursing home residents.

OBJECTIVES

To evaluate the intensity of WTL, its association with various factors, and its temporal evolution among residents ≥ 65 years old; we also aimed to compare it with proxy assessments of WTL.

METHODS

A cross-sectional study was conducted in five nursing homes in Switzerland. Participants with decisional capacity were asked to rate the intensity of their WTL on a single-item numerical rating scale ranging from 0-10. A short-term follow-up was conducted among a sub-sample of 17 participants after three and six weeks. Proxy assessment by residents' next of kin and professional caregivers was conducted, and inter-rater agreement was calculated.

RESULTS

Data from 103 participants (75.7% women, 87.3 ± 8.0 years) was analyzed. The median intensity of WTL was 8. Higher WTL was significantly associated with better physical mobility and shorter duration of daily care but not with age, gender, pre-admission care setting, or prognosis. Significant independent predictors of WTL were physical mobility and provenance from rehabilitative care. In the short-term follow-up assessment, WTL remained highly stable. Intraclass correlation coefficients were moderate for residents' next of kin and nurse assistants but poor for physicians and nurses; all proxy assessments underestimated the participants' WTL.

CONCLUSION

Nursing home residents expressed a very strong WTL and proxy aents underestimated residents' WTL. It seems pivotal to proactively communicate with residents about their WTL.

摘要

背景

生存意愿（WTL）是主观幸福感的一个重要指标。它可以帮助我们更深入地了解养老院居民的幸福感。

目的

评估≥65 岁养老院居民的 WTL 强度、其与各种因素的关联，以及其随时间的演变情况；我们还旨在将其与 WTL 的代理评估进行比较。

方法

在瑞士的五家养老院进行了一项横断面研究。有决策能力的参与者被要求在 0-10 的单项数字评分量表上评估他们的 WTL 强度。在 17 名参与者的亚样本中，在三到六周后进行了短期随访。对居民的近亲及专业护理人员进行了代理评估，并计算了组内相关系数。

结果

分析了 103 名参与者（75.7%为女性，87.3±8.0 岁）的数据。WTL 的中位数为 8。较高的 WTL 与更好的身体活动能力和较短的日常护理时间显著相关，但与年龄、性别、入院前护理环境或预后无关。WTL 的显著独立预测因素是身体活动能力和康复护理的起源。在短期随访评估中，WTL 仍然非常稳定。居民近亲、护士助理的组内相关系数为中等，但医生和护士的组内相关系数较差；所有代理评估都低估了参与者的 WTL。