意大利南蒂罗尔地区老年人对死亡地点偏好的社会、健康和生活方式决定因素——一项横断面调查研究。
Social, health and lifestyle-related determinants of older adults' preferences for place of death in South Tyrol, Italy - a cross-sectional survey study.
机构信息
Institute of General Practice and Public Health, Claudiana, Lorenz-Böhler-Str. 13, Bolzano-Bozen, 39100, Italy.
Claudiana Research, College of Healthcare Professions, Bolzano-Bozen, Italy.
出版信息
BMC Geriatr. 2024 Oct 31;24(1):899. doi: 10.1186/s12877-024-05485-1.
BACKGROUND
As the global aging population expands, understanding older adults' preferences for place of death becomes pivotal in ensuring person-centered end-of-life care.
OBJECTIVE
This study aimed to investigate the influence of sociodemographic, health, and lifestyle-related factors on end-of-life care preferences of older adults in South Tyrol, Italy.
METHODS
Employing a cross-sectional design, a population-based survey was conducted with a stratified probabilistic sample of adults aged ≥ 75 years in South Tyrol (Autonomous Province of Bolzano/Bozen, Italy). From a randomly selected sample of 3,600 older adults, participants were invited to respond to a questionnaire that included items on older adults' preferences for place of death and socio-demographic and health- and lifestyle-related factors, including frailty (e.g., PRISMA-7). Descriptive and multinomial logistic regression analyses were performed.
RESULTS
The majority (55.3%) of the 1,695 older adults (participation rate: 47%) expressed a preference for dying at home and 12.7% indicated a desire for specialized end-of-life care in a healthcare facility. However, 27.9% refrained from disclosing their end-of-life care preferences. The factors influencing these preferences concerning the place of death included age, native language, educational level, living situation, and community. Compared to the preference of dying at own home or home of family or friends, older adults aged ≥ 85 years (OR = 0.57, P = 0.002) and living in an urban area (OR = 0.40, P < 0.001) were less likely to prefer dying at a hospital, palliative care unit, or hospice. Older adults living alone (OR = 1.90, P < 0.001), Italian-speaking (OR = 1.46, P = 0.03), and those with an educational level above high school (OR = 1.69, P = 0.002) were more likely to prefer dying at a hospital, palliative care unit, or hospice.
CONCLUSIONS
End-of-life care preferences among older adults in South Tyrol were associated with socio-demographic, yet not health- and lifestyle-related factors. Recognizing and integrating these preferences is essential for developing, implementing, and evaluating interventions to promote advance care planning and provide effective, patient-centered end-of-life care.
背景
随着全球人口老龄化的加剧，了解老年人对死亡地点的偏好对于确保以患者为中心的临终关怀至关重要。
目的
本研究旨在调查南蒂罗尔（意大利博尔扎诺自治省）老年人的社会人口学、健康和生活方式相关因素对临终关怀偏好的影响。
方法
采用横断面设计，对南蒂罗尔（意大利博尔扎诺自治省）≥75 岁的成年人进行基于人群的概率分层抽样调查。从随机选择的 3600 名老年人中，邀请参与者回答一份问卷，其中包括老年人对死亡地点的偏好以及社会人口学和健康及生活方式相关因素的问题，包括衰弱（例如 PRISMA-7）。进行描述性和多项逻辑回归分析。
结果
在 1695 名老年人（参与率：47%）中，大多数（55.3%）表示希望在家中去世，12.7%表示希望在医疗保健机构接受专门的临终关怀。然而，27.9%的人拒绝透露他们的临终关怀偏好。影响这些死亡地点偏好的因素包括年龄、母语、教育水平、居住状况和社区。与在家中或家人或朋友家去世的偏好相比，年龄≥85 岁的老年人（OR=0.57，P=0.002）和居住在城市地区的老年人（OR=0.40，P<0.001）不太可能选择在医院、姑息治疗单位或临终关怀机构去世。独居的老年人（OR=1.90，P<0.001）、说意大利语的老年人（OR=1.46，P=0.03）和受过高中以上教育的老年人（OR=1.69，P=0.002）更有可能选择在医院、姑息治疗单位或临终关怀机构去世。
结论
南蒂罗尔老年人的临终关怀偏好与社会人口学因素有关，但与健康和生活方式因素无关。认识和整合这些偏好对于制定、实施和评估促进预先护理计划和提供有效、以患者为中心的临终关怀的干预措施至关重要。
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