Yao Yisong, Zhang Xinyue, Li Yumei, Xia Xiaoqian, Jiang Ling, Chen Xi, Li Limin, Wu Yibo, Song Xicheng
Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China.
Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China.
BMC Public Health. 2025 May 6;25(1):1663. doi: 10.1186/s12889-025-22892-0.
Acceptance of advance care planning (ACP) among older adults is important for the promotion of ACP. It is of great importance to explore the acceptance of ACP and associated influencing factors among older adults in China based on the health ecology model (HEM).
Based on a national cross-sectional study in 2022, 4,180 older adults were included. Stepwise linear regression was used to analyze factors associated with acceptance of ACP using SPSS 26.0, based on the HEM. Acceptance scores were calculated based on a self-assessment visual analog scale (range, 0 ~ 100, with higher scores indicating higher acceptance of ACP).
50.05% (2,092) of 4,180 participants were female. The median acceptance of ACP score was 64, and the range was (49, 81). In addition, the study found higher well-being index (β = 0.086; 95% CI, 0.199 to 0.535; P < 0.001) and health literacy (β = 0.054; 95% CI, 0.07 to 0.423; P = 0.006) scores, broader media use behaviors (β = 0.064; 95% CI, 0.127 to 0.419; P < 0.001), and a higher per capita monthly household income (β = 0.086; 95% CI, 1.827 to 3.825; P < 0.001) were associated with a higher acceptance of ACP, while participants with higher depression scores (β = -0.06; 95% CI, -0.435 to -0.129; P < 0.001), larger social network (β = -0.054; 95% CI, -3.289 to -0.937; P < 0.001), and health insurance (β = -0.04; 95% CI, -7.294 to -1.027; P = 0.008) demonstrated a lower acceptance of ACP.
For the first time, this study revealed basic personal information, economic status, media use, social networks, health knowledge, and mental health as the main factors associated with acceptance of ACP among older adults in mainland China. These findings were of great significant for enhancing healthcare quality and the overall quality of life for older adults in China.
老年人对预先护理计划（ACP）的接受程度对于推广 ACP 很重要。基于健康生态模型（HEM）探索中国老年人对 ACP 的接受程度及相关影响因素具有重要意义。
基于 2022 年的一项全国性横断面研究，纳入了 4180 名老年人。使用 SPSS 26.0，基于 HEM，采用逐步线性回归分析与 ACP 接受程度相关的因素。接受程度得分基于自我评估视觉模拟量表计算（范围为 0～100，得分越高表明对 ACP 的接受程度越高）。
4180 名参与者中 50.05%（2092 名）为女性。ACP 接受程度得分的中位数为 64，范围为（49，81）。此外，研究发现较高的幸福感指数（β = 0.086；95%CI，0.199 至 0.535；P < 0.001）、健康素养（β = 0.054；95%CI，0.07 至 0.423；P = 0.006）得分、更广泛的媒体使用行为（β = 0.064；95%CI，0.127 至 0.419；P < 0.001）以及较高的人均家庭月收入（β = 0.086；95%CI，1.827 至 3.825；P < 0.001）与较高的 ACP 接受程度相关，而抑郁得分较高的参与者（β = -0.06；95%CI，-0.43
