养老机构与社区老年人生命晚期照护意向的比较

目的 分析不同养老模式下老年人生命晚期照护意向的现状与差异。 方法 采用方便抽样法,于2016年10月—2017年6月,采用生命晚期照护意向问卷对福州市7所养老机构的194名老年人与15个社区的293名老年人的生命晚期照护意向进行横断面调查,并采用倾向值匹配法平衡两组老年人的基线后,分析养老机构老年人和社区老年人生命晚期照护意向的差异。结果 两组老年人在首选的接受照护或死亡的场所及回避死亡问题的态度上,差异均有统计学意义（P<0.05）。两组老年人对照护方式的重要程度排序、各种疾病相关信息的重要程度评价、最愿意与之讨论生命晚期照护意向的对象、在治疗无望时是否拒绝接受依赖各种生命维持治疗来维持生命等4个方面,差异无统计学意义（P>0.05）。结论 养老机构老年人和社区老年人的照护意向均以安宁疗护为主,且更愿意与家属讨论生命晚期照护议题,但社区老年人对死亡话题更敏感,老年人的生命晚期照护意向与其所处的生活情境有关。

A comparison of end-of-life care preferences between nursing home residents and community-dwellers

Objective To explore the differences of End-of-Life（EOL） care preferences between nursing home residents and community-dwelling older adults in Fuzhou,China. Methods A total of 487 older adults were recruited from 7 nursing homes and 15 communities in Fuzhou during October 2016 to June 2017,and they were investigated by End-of-Life Preferences Questionnaire（EOLPQ）. Propensity score matching was used to balance the personal information of 2 groups,and the differences in the care preferences were analyzed. Results There were significant differences in the preferred places of care or death and the attitudes towards death between 2 groups（P<0.05）. There were no significant differences between 2 groups in 4 aspects,including the rank of importance in care patterns,the degree of importance in disease information,the person they are most willing to discuss EOL care with,and whether they refuse to rely on various of life-sustaining treatments when the treatment is impossible（P>0.05）. Conclusion Both nursing home residents and community-dwelling older adults prefer hospice care at the end of their life. They are more willing to discuss EOL care with their family members. However,community-dwellers are more sensitive to the topic of death. The EOL care preferences of the elderly is related to their life situation.