武汉市养老院老年人预前指示现况及影响因素调查

Investigation of current status and predictors of advance directives among nursing home residents in Wuhan,China

目的了解养老院老年人预前指示现况,分析影响预前指示的因素。方法抽取武汉市31所养老院的老年人429人,对其人口统计学资料、生活质量(QOLC-E)、活动功能(I-ADL,P-ADL)、累积疾病状况(CIRS)、对临终医疗护理措施的态度等进行调查,分析各变量对是否愿意做预前指示的影响。结果59.2%的老年人为女性,以丧偶为主(85.8%),平均年龄(76.86±8.59)岁;老年人QOLC-E平均得分3.22±0.49;I-ADL、P-ADL得分分别为12.97±4.25,20.66±4.89;累积疾病评分4.27±2.99;53.8%的老年人在病情严重时愿意接受CPR等急救措施,79.0%的老年人会选择儿女做自己的代理人;57.3%的老年人愿意在养老院度过自己生命的最后时光;4.9%的老年人听说过预前指示;愿意做、不愿意做预前指示及不愿回答的老年人分别为31.4%、37.1%、31.5%;是否听说过预前指示、是否愿意接受急救、疾病总分是预前指示的影响因素(P<0.05,P<0.01)。结论养老院老年人对预前指示的知晓率较低,少部分老年人愿意做预前指示;应对老年人加强有关预前指示的宣教,为愿做预前指示的老年人提供平台。

Objective To explore current status and predictors of advance directives among nursing home residents. Methods Totally, 429 elderly residents living in 31 nursing homes in Wuhan were enrolled to investigate their socio-demographic data, quality of life （QOLC-E）, activity of daily living （I-ADL, P-ADL）, chronic diseases condition （CIRS） and attitudes toward life sustaining treat- ment, etc. Then the effect of those factors on the preference to advance directive was analyzed. Results In all the residents, 59.2% were female, 85.8% were widowed, and the average age was 76.86-8.59. The average score of QOLC-E was 3.22±0.49. The total scores of I-ADL and P-ADL were 12.97±4.25, 20.66±4.89 respectively. CIRS score was 4.27±2.99. Almost 53.8% residents would accept life sustaining treatments such as cardiopulmonary resuscitation （CPR） ;79.0% participants chose their chil- dren as their surrogates; 57.3%participants wanted to live in present nursing homes until the end stage of their life;4.9% resi- dents heard of advance directive, while 31.4%, 37%, 31.5% residents preferred, rejected and made no comment on advance di- rective. Whet-her hearing of advance directive, attitudes toward life sustaining treatment, score of CIRS were the predictors of ad vance directive preferences （P〈0.05 ,P〈0.01）. Conclusion The awareness rate of advance directive is low among nursing home residents, while a minority of them prefer to make advance directives： We should strengthen the education of advance directive for the elderly and provide platform for those willing to accept the education.