| Summary: | 碩士 === 國立陽明大學 === 社區健康照護研究所 === 106 === Terminal ill patients were more likely to suffer from receiving too many invasive treatments and caused them to live in the disaster and thus had worse quality of life for them. Furthermore, the aggressive treatments brought great pain and suffering to terminal ill patients and their family members. The signing of Advance directives (ADs) helps people to decide in advance what one want during the process of treatments and to increase their autonomy, espeically at the end of life. The purpose of this study was to explore the predictors of the signing Ads for elderly who residen in the community and institutions, so as to improve the autonomy of the elderly and to achieve their good end-of-life.
This study applied a cross-sectional research design to interview elderly who are 65 years old or older from one Ilan Community Care Center and one veterans home. A total of 207 valid questionnaires were completed. The results of this study showed that those who lived in the veterans home (OR=3.507, 95%CI=1.192-10.317), no spouse (OR=2.233, 95%CI=1.025-4.866), and who were graduated in the middle school or above (OR=2.876, 95% CI=1.354-6.107) were more likely to sign ADs. After adding the knowledge and attitude related to ADs in the regression model, the odds ratio of the unmarried status of subjects rose from 2.233 to 3.037. The attitude of signing ADs significantly affect the subjects whether to sign ADs or not (OR=1.192, 95%CI=1.117-1.271). There were 15 community and institutional seniors receiving qualitative interviews and showed that subjects who were with marital status, willing to have a good qualily of life, do not want to cause burden to their families, and easily access to information from health professionals were more likely to sign ADs.
Based on the findings of this study, the professionals should be alert to factors influcing elders whether sign ADs or not. It is important to inform the elders about the benefits of signing ADs. In clinical practice, it is recommendd that elders, their families, and medical personnel understand elder’s preferences and barriers of signing ADs through discuss in advance care planning together. Regarding to the suggestions of the current signing ADs related policy, government should promote signing ADs separately from organ donations in order to prevent the mis-understanding of pre-additional medical instructions. Since community elderly offen receive information through their family members and neighbourhoods, therefore, to build the partners and social network for elders has been proposed to clinical professionals to promote the sign of ADs.
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