Medical Student, The Ohio State University College of Medicine, Columbus, Ohio, USA.
Department of Medicine, The University of California San Francisco, San Francisco, California, USA.
J Am Geriatr Soc. 2023 Aug;71(8):2615-2626. doi: 10.1111/jgs.18314. Epub 2023 Mar 16.
Older adults experiencing chronic homelessness (i.e., prolonged homelessness and a disabling condition) have low rates of advance care planning (ACP) despite high rates of morbidity and mortality. Rehousing of homeless-experienced individuals into permanent supportive housing (PSH) may present an opportunity to introduce ACP; but this is unknown. Therefore, we explored staff and resident perceptions of conducting ACP in PSH.
We conducted semi-structured interviews with PSH staff (n = 13) and tenants (PSH residents) (n = 26) in San Francisco. We used the capability (C), opportunity (O), motivation (M), behavior (COM-B) framework within the Behavior Change Wheel model and the Theoretical Domains Framework (TDF) to inform interviews, categorize themes, and guide qualitative thematic analysis.
The mean age of PSH residents was 67 (SD = 6.1) years and 52% were women. Of staff, 69% were women. Important COM-B barriers included ACP complexity (C), complicated relationship dynamics (O), resource limitations (O), pessimism (M), variable staff confidence (M), and competing priorities (M). Facilitators included easy-to-use documents/videos, including the PREPARE for Your Care program (C), stability with housing (O), exposure to health crises (O), potential for strong relationships (O), and belief that ACP is impactful (M). Recommendations included adapting materials to the PSH setting, providing staff trainings/scripts, and using optional one-on-one or group sessions.
We identified behavioral determinants related to ACP for formerly chronically homeless older adults in PSH. Future interventions should include using easy-to-use ACP materials and developing resources to educate PSH residents, train staff, and model ACP in groups or one-on-one sessions.
尽管患有慢性疾病和残疾的老年无家可归者（即长期无家可归和残疾）的发病率和死亡率很高，但他们进行预先护理计划（ACP）的比例却很低。将有过无家可归经历的人安置到永久性支持性住房（PSH）中可能是引入 ACP 的机会；但这是未知的。因此，我们探讨了工作人员和居民对在 PSH 中进行 ACP 的看法。
我们在旧金山对 PSH 工作人员（n=13）和租户（PSH 居民）（n=26）进行了半结构化访谈。我们使用行为改变车轮模型中的能力（C）、机会（O）、动机（M）、行为（COM-B）框架和理论领域框架（TDF）来指导访谈、分类主题和指导定性主题分析。
PSH 居民的平均年龄为 67 岁（标准差=6.1），其中 52%为女性。工作人员中，69%为女性。重要的 COM-B 障碍包括 ACP 复杂性（C）、复杂的关系动态（O）、资源限制（O）、悲观主义（M）、不稳定的员工信心（M）和竞争优先级（M）。促进因素包括易于使用的文档/视频，包括 PREPARE for Your Care 计划（C）、住房稳定（O）、接触健康危机（O）、建立良好关系的潜力（O）和对 ACP 有影响的信念（M）。建议包括调整材料以适应 PSH 环境、提供员工培训/脚本，以及使用可选的一对一或小组会议。
我们确定了与 PSH 中以前长期无家可归的老年成年人进行 ACP 相关的行为决定因素。未来的干预措施应包括使用易于使用的 ACP 材料，并开发资源来教育 PSH 居民、培训工作人员，并在小组或一对一会议中示范 ACP。
