社区老年居民及家属预先指示知识和态度及其影响因素研究

背景　社区老年居民是预先指示的重点应用人群之一,了解社区老年居民及家属的预先指示知识和态度有助于预先指示的推广应用。目的　了解社区老年居民及家属对预先指示的知识和态度,并探讨预先指示接受度的影响因素。方法　采用一般资料调查表、预先指示知识量表和预先指示态度问卷,于2019年11-12月对天津市滨海新区塘沽街10个社区的200例社区老年居民和200例家属进行调查。结果　社区老年居民回收问卷170份,家属回收问卷180份。社区老年居民及家属预先指示知识量表中位得分分别为0（0,0）、0（0,0）分。社区老年居民对预先指示的知晓率和接受度分别为6.5%（11/170）和41.2%（70/170）,家属为10.6%（19/180）和58.9%（106/180）。Logistic逐步回归分析结果显示,影响社区老年居民预先指示接受度的因素包括：文化程度、病情难以逆转或疾病晚期是否放弃治疗、病情难以逆转或在疾病晚期生存质量还是生存时间重要、是否听说过预先指示（P<0.05）;影响家属预先指示接受度的因素包括：文化程度、与老人居住方式、预先指示知识水平、病情难以逆转或疾病晚期是否应采取对症治疗、是否听说过生前预嘱（P<0.05）。结论　社区老年居民及家属对预先指示的了解甚少,接受度有待提高,社区居民预先指示知识教育需加强。社区医护人员应对社区居民及家属开展预先指示宣传,让更多社区居民及家属了解预先指示。

Knowledge and Attitudes Regarding Advance Directives and Associated Factors among Community-dwelling Older Adults and Families

Background　Community-dwelling elderly residents are a key group for the use of advance directives. Understanding the knowledge and attitudes regarding advance directives among these residents and families helps to promote the use of advance directives. Objective　To explore the knowledge and attitudes regarding advance directives and associated factors among community-dwelling elderly residents and their families. Methods　This survey was carried out from November to December 2019 using the Demographic Information Questionnaire developed by our research group,Knowledge of Advance Directives Scale（KADS） and Attitudes Towards Advance Directives Scale（AADS）. Participants were elderly residents（n=200） and family members（n=200） selected from 10 communities in Tanggu Street,Binhai New Area of Tianjin. Results　170 questionnaires were collected from the elderly residents in the community and 180 questionnaires were collected from family members. The median scores of KADS for older residents and their families were 0（0,0）,0（0,0）,respectively. The rates of knowing advance directives for older residents and family members were 6.5%（11/170） and 10.6%（19/180）,respectively. The rates of accepting advance directives for older residents and family members were 41.2%（70/170） and 58.9%（106/180）,respectively. Stepwise Logistic regression analysis showed that education level,whether to give up treatment and valuing quality of life or survival time when the conditions are difficult to be reversed or at the late stage of the disease,and prevalence of hearing about advance directives were independently associated with the acceptance of advance directives in the older residents（P<0.05）. And education level,living style with the elderly, and knowledge of advance directives,opinion of whether use of symptomatic treatment when the condition is difficult to be reversed or at the late stage of the disease,and prevalence of hearing about living will were independently associated with the acceptance of advance directives in familie members（P<0.05）. Conclusion　The levels of knowledge of advance directives among these community-dwelling elderly residents and familiee members are quite low,and their acceptances of advance directives need to be improved. In view of this,related education for them should be strengthened via the propaganda of advance directives by community medical and nursing care workers.