Advance Directive Completion by Elderly Americans: A Decade of Change
Advance Directive Completion by Elderly Americans: A Decade of Change
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DOI：
10.1111/jgs.12736
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发表时间：
2014-04-01
影响因子：
6.3
通讯作者：
Piette, John
中科院分区：
文献类型：
--
作者：
Silveira, Maria J.;Wiitala, Wyndy;Piette, John
目的描述2000年至2010年提前指令（AD）完成的趋势，并探讨AD与住院和临终时医院死亡之间的关系。设计回顾性队列研究。设置健康与退休研究（HRS）。2000年至2010年期间死亡的60岁及以上HRS参与者（N=6，122）.描述了AD完成率、死亡前住院率和住院死亡率随时间的趋势。然后通过比较嵌套的多变量logistic回归模型来评估AD完成趋势与医院死亡之间的相关性，该模型预测随着时间的推移，在调整和不调整AD状态和社会人口学特征的情况下医院死亡的几率。复杂的抽样设计占在所有的analysis.ResultsThe死者的比例与AD从2000年的47%增加到2010年的72%。与此同时，在生命的最后20年中至少住院一次的死亡者比例从52%上升到71%，在医院死亡的比例从45%下降到35%。调整混杂的社会人口学特征，在过去的十年中，在医院死亡率下降的趋势可以忽略不计与更多的使用ADs.ConclusionThere有一个显着的增加，在过去的十年中，AD完成率，但这种趋势对住院和住院死亡的影响不大，这表明AD完成是不可能阻止住院死亡前。
ObjectivesTo describe trends in advance directive (AD) completion from 2000 to 2010 and to explore the relationship between AD and hospitalization and hospital death at the end of life.DesignRetrospective cohort study.SettingHealth and Retirement Study (HRS).ParticipantsHRS participants who died between 2000 and 2010 and were aged 60 and older at death (N=6,122).MeasurementsTrends over time in rates of AD completion, hospitalization before death, and death in hospital are described. The association between trends in AD completion and hospital death was then assessed by comparing nested, multivariable logistic regression models predicting the odds of hospital death over time with and without adjusting for AD status and sociodemographic characteristics. The complex sampling design was accounted for in all analyses.ResultsThe proportion of decedents with an AD increased from 47% in 2000 to 72% in 2010. At the same time, the proportion of decedents with at least one hospitalization in the last 2years of life increased from 52% to 71%, and the proportion dying in the hospital decreased from 45% to 35%. After adjusting for confounding by sociodemographic characteristics, the trend in declining hospital death over the decade was negligibly associated with the greater use of ADs.ConclusionThere has been a significant increase in rates of AD completion over the last decade, but this trend has had little effect upon hospitalization and hospital death, suggesting that AD completion is unlikely to stem hospitalization before death.