以需求为导向的社区老年人死亡教育初步实践成效

The primary effect of demand-oriented death education for the elderly in community

目的通过对社区老年人死亡教育的实践探索,为开展民众死亡教育提供借鉴。方法 2019年4—11月,在北京市某社区1家养老院及1个居民小区选取≥60岁老年人60人,以需求为导向,按死亡教育的"死亡本质、死亡态度、死亡准备、超越死亡"的4阶梯理论,进行4次递进式死亡教育;采用"死亡教育需求调查表"了解被教育者基本信息和死亡教育需求,采用"死亡态度描绘量表""临终与死亡问题对待与处理量表"了解教育前后状况。结果教育前有效调查60人,教育后有效调查58人,死亡教育需求7个条目得分由高到低,依次为临终治疗与死亡相关问题看待(4.15±0.57)、死亡准备与后事安排(4.12±0.77)、哀伤的处理与应对(4.07±0.65)、临终与死亡相关话题的沟通技巧(3.98±0.75)、临终陪伴与照顾技能(3.98±0.52)、临终与死亡的相关知识了解(3.96±0.81)、临终治疗与救治意愿表达(3.91±0.85),均处于或接近"需要"水平。经4个主题死亡教育后,死亡态度5个维度中的死亡恐惧(2.47±0.76)和死亡逃避(3.07±0.76)2个维度得分,较教育前(2.77±0.86、3.47±0.65)均降低(t值分别为2.02、3.05,P值均<0.05);临终与死亡问题对待处理5个维度中仅临终意愿表达维度得分(4.28±0.46)与教育前(3.92±0.32)差异有统计学意义(t=3.39,P<0.05)。结论社区老年人对死亡教育有较高需求,递进式死亡教育能有效改善死亡态度,但对临终与死亡问题处理能力提升有限,应持续开展民众死亡教育。

Objective To provide reference and guidance for follow-up people′s death education through the practical exploration of community elderly death education.Methods From Apr to Nov 2019,a total of 60 elderly subjects were selected from one nursing home and one residential community in a community of Beijing.Oriented by the demands,according to the four step theory of death essence,death attitude,death preparation and surpassing death,four step progressive death theory education was carried out.The Death education demand questionnaire was used to study the basic information,the Death attitude description scale and The dying and death treatment scale were used to investigate the situation before and after education.Results A total of 60 and 58 subjects were investigated before and after education,respectively.The demand scores of the 7 items of death education were treatment of dying and death related problems(4.15 ± 0.57),death preparation and aftercare arrangement(4.12 ± 0.77),grief treatment and response(4.07 ± 0.65),communication skills on dying and death related topics(3.98 ± 0.75),dying company and care skills(3.98 ± 0.52),knowledge on dying and death(3.96 ± 0.81),the expression of hospice treatment and treatment intention(3.91 ± 0.85);all were at or close to the level of "need".After education,scores of 2 dimensions of death fear(2.47 ± 0.76) and death avoidance(3.07 ± 0.76) in death attitude decreased compared with corresponding scores before education(2.77±0.86 and 3.47±0.65),the differences were statistically different(all P<0.05).For the treatment of dying and death problems,only the score of dying will expression dimension(4.28 ± 0.46) was significantly different compared to that before education(3.92 ± 0.32)(P<0.05).Conclusion The elderly in the community have a high demand for death education.Progressive death education can effectively improve death attitude,but have limited improvement for the ability to deal with the issues of dying and death.The death education should be carried out continuously among people.