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老年住院患者急诊入院后对预先医疗照护计划的看法:一项定性研究。

Views of advance care planning in older hospitalized patients following an emergency admission: A qualitative study.

机构信息

Department of Surgery and Cancer, Imperial College London, London, United Kingdom.

Imperial College Healthcare NHS Trust, London, United Kingdom.

出版信息

PLoS One. 2022 Sep 1;17(9):e0273894. doi: 10.1371/journal.pone.0273894. eCollection 2022.

Abstract

BACKGROUND

There is increasing evidence of the need to consider advance care planning (ACP) for older adults who have been recently admitted to hospital as an emergency. However, there is a gap in knowledge regarding how to facilitate ACP following acute illness in later life.

AIM/OBJECTIVES: To explore the perceived impact of ACP on the lives of older persons aged 70+ who have been acutely admitted to hospital.

METHOD

Semi-structured qualitative interviews were conducted with older adults aged 70+ who were admitted to hospital as an emergency. Thematic analysis was enhanced by dual coding and exploration of divergent views within an interdisciplinary team.

RESULTS

Twenty participants were interviewed. Thematic analysis generated the following themes: (1) Bespoke planning to holistically support a sense of self, (2) ACP as a socio-cultural phenomenon advocating for older persons rights, (3) The role of personal relationships, (4) Navigating unfamiliar territory and (5) Harnessing resources.

CONCLUSION

These findings indicate that maintaining a sense of personal identity and protecting individuals' wishes and rights during ACP is important to older adults who have been acutely unwell. Following emergency hospitalization, older persons believe that ACP must be supported by a network of relationships and resources, improving the likelihood of adequate preparation to navigate the uncertainties of future care in later life. Therefore, emergency hospitalization in later life, and the uncertainty that may follow, may provide a catalyst for patients, carers and healthcare professionals to leverage existing or create new relationships and target resources to enable ACP, in order to uphold older persons' identity, rights and wishes following acute illness.

摘要

背景

越来越多的证据表明,有必要考虑为最近因急症住院的老年人制定预先护理计划(ACP)。然而,对于如何在晚年急性病后促进 ACP,人们的知识还存在差距。

目的/目标:探索 ACP 对 70 岁以上因急症住院的老年人生活的感知影响。

方法

对 70 岁以上因急症住院的老年人进行半结构化定性访谈。通过双编码和跨学科团队内的不同观点探索,增强主题分析。

结果

共采访了 20 名参与者。主题分析生成了以下主题:(1)定制计划以全面支持自我意识,(2)ACP 作为倡导老年人权利的社会文化现象,(3)个人关系的作用,(4)驾驭陌生领域,(5)利用资源。

结论

这些发现表明,在 ACP 中维护个人身份意识并保护个人的意愿和权利对因急症而身体不适的老年人很重要。在因急症住院后,老年人认为 ACP 必须得到人际关系和资源网络的支持,这增加了在晚年为应对未来护理的不确定性做好充分准备的可能性。因此,晚年的急症住院以及随之而来的不确定性,可能为患者、照顾者和医疗保健专业人员提供一个契机,利用现有的或创建新的关系,并针对资源进行 ACP,以维护老年人在急性病后的身份、权利和意愿。

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