Division of Health Policy, Bureau of Health Policy, Ministry of Health and Welfare, Sejong-si 30113, Korea.
Division of Medical Law & Ethics, Department of Medical Humanities and Social Sciences, Yonsei University College of Medicine, Seoul 03722, Korea.
Int J Environ Res Public Health. 2022 Mar 22;19(7):3771. doi: 10.3390/ijerph19073771.
Advance directives (ADs) can support autonomy in making healthcare decisions and minimize unnecessary discomfort during the treatment process at the end of life (EOL). This study aimed to investigate the factors that influence AD documentation among community-dwelling older adults. We used data from the National Survey of Older Koreans which was conducted nationwide in 2020. Data from participants aged 65 years or older were extracted using stratified multistage cluster sampling and the survey was conducted through one-on-one interviews. A total of 9920 older adults were included in this study: 421 respondents (4.7%) claimed that they had prepared for AD. Multivariable logistic regression analysis showed that being 75 years or older, having higher educational attainment, higher income, having any chronic disease(s), being screened for dementia in the past, being against futile life-sustaining treatment, taking a lecture on death and being registered for organ donation were positively associated with AD. Furthermore, when health was rated as average, it was associated with reduced odds of AD documentation compared when health was rated as good. These results suggest that more targeted efforts are required to promote EOL discussions among older adults.
预先指示 (AD) 可以支持在做出医疗保健决策时的自主性，并在生命末期 (EOL) 的治疗过程中最大限度地减少不必要的不适。本研究旨在调查影响社区居住的老年人 AD 记录的因素。我们使用了 2020 年在全国范围内进行的全国韩国老年人调查的数据。使用分层多阶段聚类抽样从年龄在 65 岁及以上的参与者中提取数据，并通过一对一访谈进行调查。本研究共纳入 9920 名老年人：421 名受访者（4.7%）表示他们已经为 AD 做了准备。多变量逻辑回归分析显示，75 岁或以上、受教育程度较高、收入较高、患有任何慢性疾病、过去接受过痴呆症筛查、反对无益的维持生命治疗、参加过关于死亡的讲座和登记器官捐赠与 AD 呈正相关。此外，当健康状况被评为一般时，与 AD 记录的可能性降低相关，而当健康状况被评为良好时，则与 AD 记录的可能性降低相关。这些结果表明，需要更有针对性的努力来促进老年人的 EOL 讨论。
