ADVANCE DIRECTIVES AMONG THE OLDEST OLD

描述：提前指令已被宣传为一种认识到 病人在自己的医疗保健决策中的重要性。通过 记录使用维持生命的医疗治疗的偏好， 先行指令的支持者希望尊严、个人的价值观 自主性和舒适性最终将在治疗决策中发挥更大的作用 生活的一部分。大多数关于先行指令的完成和使用的研究都有 重点是住院病人或疗养院居民。几项研究 已经检查了门诊样本中的提前指示。已经很少有 然而，对先行指令的存在或使用的研究 基于总体的样本。拟议的研究将涉及以下问题 具体研究问题：(1)提前指令的流行度是多少？ 在1994至1995年间去世的社区老年人中？(2)什么？ 健康和社会人口因素与使用Advance有关 在1994至1994年间去世的社区居住老年人中的指令 1995年？(3)提前指令的使用与 人们死亡的环境(例如，家庭、医院、疗养院或临终关怀所)？ 以及(4)老年人的提前指示对健康有什么影响 死亡前的费用和症状经历？ 拟议的研究将使用来自资产和健康动力学的数据 最古老的旧(前)第二波退出调查。提前调查是一项全国性的调查 1993年对70岁以上人群的代表性纵向小组调查 (第一波)。离职调查是与参与者的代理告密者一起进行的 在第一波中，谁在第二波之前死亡。拟议的研究将使一个重要的 有助于我们理解提前指令如何塑造生命的终结 关心。以前的研究表明，提前指令通常不会 在生命末期对卫生保健的使用产生重大影响。然而， 这些研究大多调查了在医院接受医疗护理的人。 布景。因此，目前尚不清楚那些考虑过自己的 对临终关怀的偏好，并已编写了一份提前指令或 被指定为医疗保健委托书的人可能会避免去 生前在医院或疗养院。这样的发现表明，大多数人 以前的研究容易受到选择偏差的影响。通过使用来自 基于社区的样本，我们将能够解决这一重大限制 在关于先行指令的文献中。这项研究将产生初步的 这些发现将为利用这些数据进行进一步研究提供背景。

DESCRIPTION: Advance directives have been promoted as a way to recognize the importance of patients in making decisions about their own health care. By documenting preferences for the use of life sustaining medical treatments, proponents of advance directives hope that the values of dignity, personal autonomy and comfort will play a larger role in treatment decisions at the end of life. Most research on the completion and use of advance directives has focused on hospitalized patients or nursing home residents. Several studies have examined advance directives in outpatient samples. There have been few studies, however, of the presence or use of advance directives in population-based samples. The proposed study will address the following specific research questions: (1) What is the prevalence of advance directives among community-dwelling older people who died between 1994 and 1995? (2) What health and socio-demographic factors are associated with use of advance directives among community-dwelling older people who died between 1994 and 1995? (3) What is the relationship between the use of advance directives and the setting (i.e., home, hospital, nursing home, or hospice) where people die? And (4) What is the effect of the older person's advance directives on health expenses and experience of symptoms before death? The proposed study will use data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) Wave 2 Exit Survey. The AHEAD survey is a nationally representative longitudinal panel survey of people who were over 70 in 1993 (Wave 1). The Exit Survey was conducted with proxy informants for participants in Wave 1 who died before Wave 2. The proposed study will make an important contribution to our understanding of how advance directives shape end of life care. Previous studies have suggested that advance directives often do not have a major impact on the use of health care at the end of life. However, the majority of these studies examined people receiving health care in a hospital setting. It is unknown, therefore, whether people who have considered their preferences for end of life care and have written an advance directive or designated a health care power of attorney are likely to avoid going to a hospital or nursing home before death. Such a finding would suggest that most previous studies are subject to selection bias. By using data from a community-based sample, we will be able to address this significant limitation in the literature on advance directives. This study will produce preliminary findings that will provide the background for further research with these data.