A study of advance directives completion of older residents in Veteran’s Home

• Main Authors: CHEN, JOU-CHIA, 陳柔佳
• Other Authors: KAO, TI-LI
• Format: Others
• Language: zh-TW
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/93008854342579515876

碩士 === 東海大學 === 社會工作學系 === 103 === The trend of demographic aging in Taiwan leads to the importance of end-of-life health care issues. The proportion of the elderly veterans is much higher than all population. Elderly veterans are facing challenge regarding to end-of-life care, in particular, to select the way of health care. Most of the elderly residents in Veterans Home are aging and single, therefore it stresses the importance of considering end-of-life care in advance. Advance directives and end-of-life health care are related to each other. According to Hospice Palliative Care Act, this study used a letter of "intent for the choice of hospice palliative care or life-sustaining treatment", and a letter of "intent for the choice of designating a medical surrogate agent in advance" to measure advance directives. Based on the "Integrated Behavioral Model", this study investigated relevant factors in behaviors and intentions of advance directives completion, and researched behaviors and intentions of advance directives completion of elderly residents in two Veterans Homes. In this study, a survey research method with interview schedule was used to collect needed data. Overall, 150 veterans had been interviewed and obtained 141 valid questionnaires. Data analysis showed that the ratio of advance directives completion of elderly residents in two Veterans Homes was 18.4%. As to relevant factors in behaviors and intentions of advance directives completion, this study founded the period of elderly veterans reside at Veterans Home; activities of daily living functions of elderly veterans; knowledge and skills to complete advance directives; necessity and environmental constrains of advance directive completion; attitude, perceived norm and personal agency about advance directive completion, and cultural values of elderly veterans when they are facing with disease and death. However, the association between advance directive completion and elderly veterans experience of illness and death was not founded. Furthermore, results were intention for the choice of hospice palliative care or life-sustaining treatment was a little higher than of designating a medical surrogate agent in advance; the vast majority of veterans do not want to accept CPR when they are nearing their end, but so few actually take action. Finally, background factors were connected with the advance directives completion through the function of intermediary factors. Based on research results and findings, recommendations of this study are as follows： In practice aspect, advocacy of advance directives to elderly veterans as early as possible is suggested, and it needs different strategies for nursing team and maintenance team. Social workers play the role of educator, communicator and supporters and they can take various actions to modify mediating factors. In institutional aspect, to advocate in appropriate time can bring thinking in advance is recommended. The advocacy of advance directives should be integrated into the service programs and it needs constant communication in Veterans Home. Agency staff also should receive education and training, to enrich their knowledge of advance directives. Future research is recommended into account the views of agency staff and veterans families. Additionally, based on the data obtained of this study, it can expand on background factors and mediating factors of advance directives incompletion.