The Factors Associated with the Do-Not-Resuscitate Decision or Intention Among Elderly Nursing Home Residents
|Keywords:||護理之家;老年住民;代理家屬;不施行心肺復甦術;決策意向;預測因子;Nursing home;elder resident;family surrogate;Do-Not-Resuscitate decision or intention;predictors||Issue Date:||2011||Abstract:||
方法：本研究採橫斷式相關性研究設計，自北部某地區醫院護理之家，立意取樣65歲(含)以上老年住民及其代理家屬(n = 177)，研究工具為巴氏量表、攜帶式簡短心智量表、老人憂鬱量表、及自擬結構式問卷，透過病歷回顧及問卷訪談收集資料，包含老年住民特質、代理家屬屬性、不施行心肺復甦術決策意向之現況，並運用統計軟體SPSS 15.0版進行資料分析，以多變項邏輯式迴歸探討老年住民不施行心肺復甦術決策/意向之預測因子。
結果：在不施行心肺復甦術之決策方面，老年住民不施行心肺復甦術之意願書/同意書簽署比率低(9%)，且由家屬代理不施行心肺復甦術簽署(79%)之現象普遍。而老年住民不施行心肺復甦術之決策預測因子，包含老年住民年齡(OR = 1.16, 95% CI = 1.05 - 1.28)、離婚及鰥寡之老年住民(OR = 7.95, 95% CI = 1.33 - 47.72)、罹患癌症者(OR = 9.70, 95% CI = 1.59 - 59.10)、肺部疾病者(OR = 5.44, 95% CI = 1.29 - 22.94)、骨骼肌肉系統疾病者(OR = 4.82, 95% CI = 1.12 - 20.75)。另在老年住民不施行心肺復甦術之意向方面，有56.7%老年住民及76.9%代理家屬，均贊成為老年住民簽署不施行心肺復甦術，而老年住民不施行心肺復甦術之意向預測因子，僅全家有達成共識(OR = 28.80, 95% CI = 2.43 - 341.09)為統計上顯著之影響因子。
Background: The majority of service population of Taiwan’s nursing homes are disabled senior residents. The elderly stage is approaching the stage of death. A good death is a critical issue for disabled senior residents. However, the affecting factors of do-not-resuscitate (DNR) decision or intention among disabled senior residents at nursing homes are rarely explored in the literature. This study was to investigate the factors associated with the DNR decision or intention among elderly nursing home residents in Taiwan.
Methods: This was a cross-sectional and correlational study design using a purposive sampling to recruit ≧ 65 year-old residents and their family(n = 177) from a nursing home of the district hospital in northern Taiwan. The measurement tools included Barthel Index, Short Portable Mental Status Questionnaire, Geriatric Depression Scale, and self-designed constructive questionnaires. Data were collected by questionnaires, face to face interview, and medical chart review including characteristics of elderly residents and family surrogates and DNR decision or intention. Data were analyzed using multivariate logistic regressions of SPSS 15.0.
Results: Only 9% of senior residents signed DNR. The majority of family (79%) surrogates made the DNR decision for senior residents. Multivariate logistic regression showed that resident’s age (OR = 1.16, 95% CI = 1.05 - 1.28), divorced and widowed residents (OR = 7.95, 95% CI = 1.33 - 47.72), resident with cancer (OR = 9.70, 95% CI = 1.59- 59.10), lung disease (OR = 5.44, 95% CI = 1.29 - 22.94), or muscle and skeletal disease (OR = 4.82, 95% CI = 1.12 - 20.75) were significant predictor for resident’s DNR decision. In addition, most elderly (56.7%) and their family surrogates (76.9%) agreed with signed DNR for senior residents. Family consensus of DNR (OR = 28.80, 95% CI = 2.43 - 341.09) was the only significant factor associated with resident’s DNR intention.
Conclusions: Most elderly residents of nursing homes were cognitive impairment and their DNR decisions were made by family surrogates. There was a discrepancy between senior residents and their family proxies on DNR decision and intention. Facilitating family consensus on resident’s DNR to making actual DNR decision and end-of-life care are important for nursing home elderly residents. Future studies can conduct a qualitative study to understand elderly resident’s and family proxy’s perspectives and to establish advanced care planning early. Thus, the end-of-life care was determined by elderly resident’s self-determination.
|Appears in Collections:||護理學系所|
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