Factors during senescence that prevent advance decision-making regarding AHN
10.14442/generalist.39.2
- VernacularTitle:老年期の人工的水分・栄養補給法に対する事前の意思を決められないことに関連する要因
- Author:
Miki Miyamoto
;
Hideto Takahashi
;
Hitomi Matsuda
- Publication Type:Journal Article
- From:An Official Journal of the Japan Primary Care Association
2016;39(1):2-12
- CountryJapan
- Language:Japanese
-
Abstract:
Purpose : This study aimed to explore the factors which interfere with advance decision-making with regards to artificial hydration and nutrition (AHN) in the senescent population.
Methods : Subjects were local residents aged 60 years or older who were leading an independent life and who could go out by themselves. A cross-sectional study using a self-administered questionnaire was conducted from August to November 2011. Valid responses were obtained from 116 subjects, for a valid response rate of 90.6%. Advance AHN decisions, knowledge about AHN, intentions regarding advance directives and end-of-life care, experience providing long-term care, in addition to other questions, were analyzed using a multiple logistic regression model.
Results : With respect to advance decisions regarding AHN, 25 respondents (21.6%) indicated that they could not make a decision, while 91 respondents (78.4%) could. Sixteen respondents (13.8%) desired some component of AHN, while 75 respondents (64.7%) did not desire any AHN. Factors related to difficulty with advance decisions regarding AHN were : 1) lack of adverse experiences associated with decreased cognitive function (“experience of failure”) (OR=12.0, 95%CI=1.42-100.41, p<.022), 2) lack of experience providing long-term care for a family member (“experience of caring”) (OR=3.0, 95%CI=1.04-8.53, p<.042), and 3) desire to defer such decisions to others in the event of unconsciousness or other incompetency rather than an advance decision (“reliance on others”) (OR=5.6, 95%CI=1.95-16.24, p<.001).
Conclusion : Factors related to difficulty with advance decisions regarding AHN in the senescent population were lack of adverse experiences associated with decreased cognitive function, lack of experience providing long-term care for a family member, and desire to defer such decisions to others in the event of unconsciousness or other incompetency rather than an advance decision.
