Older people's views about home as a place of care at the end of life
Older people's views about home as a place of care at the end of life
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DOI：
10.1191/0269216304pm889oa
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发表时间：
2004-01-01
影响因子：
4.4
通讯作者：
Ahmedzai, S
中科院分区：
文献类型：
--
作者：
Gott, M;Seymour, J;Ahmedzai, S
目的：探讨老年人临终时对家作为护理场所的态度。设计：采用焦点小组和半结构化访谈的两阶段定性研究。参与者：进行了8次焦点小组讨论，有32名参与者从英国谢菲尔德的六个有目的地选择的老年人社区团体中招募。另有16名男性和29名女性参加了半结构化访谈。结果：参与者认为家不仅仅是一个物理位置，它代表着熟悉、舒适和亲人的存在。虽然参与者预期家将是他们临终关怀的理想场所，但许多人也认识到与之相关的实际和道德问题。有些人没有正式的职业。另一些人则不想成为家人和朋友的“负担”，或者担心这些人目睹他们的痛苦。那些有孩子的人不希望他们提供过于亲密的照顾。有人对可在家中提供的护理质量表示关切，特别是在适应保健技术和提供适当的症状缓解方面。他们还对那些物质条件差的人表示担忧。对于家中是否有专业护理人员，人们表达了不同的看法。尽管他们被视为为非正式的照顾者提供了急需的支持，但“陌生人”的存在被一些人认为是侵入性的，损害了“家”的理想。讨论：老年人认为与“家”相关的因素对他们的善终至关重要，最明显的是朋友和家人的陪伴，但许多人预计，他们更愿意在死后在其他地方得到照顾。这些发现与医疗化的、机构性的死亡不可能是“善死”的假设背道而驰。重要的是，在医院死亡不应被妖魔化，而应努力研究机构死亡如何具有更有意义的性质。
Objectives: To explore the attitudes of older people towards home as a place of care when dying. Design: A two-phase qualitative study using focus groups and semi-structured interviews. Participants: Eight focus group discussions were held with 32 participants recruited from six purposively selected community groups representing older people in Sheffield, UK. A further 16 men and 29 women participated in semi-structured interviews. Results: Participants identified that home was more than a physical location, representing familiarity, comfort and the presence of loved ones. While participants anticipated that home would be their ideal place of care during dying, practical and moral problems associated with it were recognised by many. Some had no informal carer. Others did not want to be a 'burden' to family and friends, or were worried about these witnessing their suffering. Those who had children did not wish them to deliver care that was unduly intimate. Concerns were expressed about the quality of care that could be delivered at home, particularly in relation to accommodating health technologies and providing adequate symptom relief. Worries were also expressed about those living in poor material circumstances. Mixed views were expressed about the presence of professional carers within the home. Although they were seen to provide much needed support for the informal carer, the presence of 'strangers' was regarded by some as intrusive and compromising the ideal of 'home'. Discussion: Older people perceive factors they associate with 'home' as crucial to a good death, most notably presence of friends and family, but many anticipate that they would prefer to be cared for elsewhere when dying. These findings run counter to assumptions that the medicalised, institutional death cannot be a 'good death'. It is important that dying in hospital is not demonized, but rather efforts made to examine how institutional deaths can take on a more meaningful quality.