Health care decisions among elderly long-term care residents and their potential proxies.
Health care decisions among elderly long-term care residents and their potential proxies.
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老年长期护理居民及其潜在代理人的医疗保健决策。
DOI：
10.1001/archinte.1989.00390060091019
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发表时间：
1989
影响因子：
--
通讯作者：
Bita Rahbar
中科院分区：
文献类型：
--
作者：
J. Ouslander;A. Tymchuk;Bita Rahbar
七十名居民的长期护理设施的住宅护理部分被要求作出健康决定后，提出了四个临床小插曲。两个小插曲涉及高风险的程序（主动脉瓣置换术和颈动脉内膜切除术）和两个低风险（流感疫苗接种和精神药物）。将老年参与者做出的决定与潜在代理人（包括参与者最近的亲属以及该机构的护士、社会工作者和医生）对这些决定的预测进行比较。老年参与者做出的决定与潜在代理人认为他们会做出的决定之间的一致率很低。参与者的实际决定与其亲属预测的决定之间的一致性最高。医生认为参与者会为两个高风险的小插曲选择什么和参与者实际选择什么之间的一致性最低。老年参与者的决策质量也由潜在的代理人和研究人员在四点量表上进行评级。老年人决策能力质量的最高评分是由亲属给出的。一个显着的负相关性之间的老年人的年龄和决策的评级分配的医生，和显着的正相关性之间的精神状态和决策评级的其他评级。这些数据具有重要的意义，设计和实施战略，以最大限度地提高老年人在长期护理环境中参与决定他们的医疗保健的能力。
Seventy residents of the residential care section of a long-term care facility were asked to make health decisions after being presented four clinical vignettes. Two vignettes involved high-risk procedures (aortic valve replacement and carotid endarterectomy) and two were low risk (flu vaccination and psychotropic medication). Comparisons were made between decisions made by the elderly participants and predictions of those decisions by potential proxies, including the participant's closest relative and a nurse, a social worker, and a physician in the facility. There was a low rate of agreement between decisions made by the elderly participant and the decisions the potential proxies thought they would make. The highest agreement was found between the participants' actual decision and the decision predicted by their relatives. The lowest agreement occurred between what the physician thought the participant would choose for the two high-risk vignettes and what the participant actually chose. The quality of the elderly participant's decisions was also rated on a four-point scale by the potential proxy, as well as by a researcher. Highest ratings of the quality of the elderly person's decision-making ability were assigned by the relative. A significant negative correlation was obtained between the elderly person's age and the decision-making rating assigned by the physician, and significant positive correlations were obtained between mental status and decision-making ratings by the other raters. These data have important implications for designing and implementing strategies to maximize the ability of elderly people in long-term care settings to participate in decisions about their health care.