[[alternative]]Attitudes toward death and advance directive among community-dwelling elderly

[[abstract]]本研究目的在探討居住於社區情境中之老人，對死亡態度、預立醫療指示的認識及簽署預立醫療指示的意願，採量性、橫斷式研究設計。以台北市65歲以上的社區老人為研究對象，以結構式問卷進行資料收集，共收案127位。研究工具包括：基本人口學資料、死亡態度量表、對於預立醫療指示的認知之問卷等工具，資料收集後以spss 17.0統計軟體進行資料分析，包括描述性統計、t檢定、One Way ANOVA及卡方檢定等推論性統計。研究結果顯示：研究對象，平均年齡為72.87歲，女性多於男性，自覺身體健康狀況以普通居多。在死亡態度方面，以中性死亡接受面向得分最高，死亡恐懼面向得分最低。在影響死亡態度相關因子方面，自覺健康狀況差及普通者，較傾向於「死亡逃避」及「死亡恐懼」；教育程度則在「中性死亡接受」面向有顯著差異；有宗教信仰者較傾向「趨近導向死亡接受」；自覺對宗教虔誠度較低者，較傾向於「死亡恐懼」；曾有接觸死亡相關經驗者，對於死亡顯得較不恐懼，較能抱持正向態度面對死亡。在死亡態度與預立醫療指示之相關性方面，死亡態度傾向「趨近導向死亡接受」者，事先預立醫療指示之意願較高。而影響老人簽署醫療指示之因素包括：曾經接受生前預囑相關訊息、了解相關法律之規範、知道可隨時更改預囑內容及決定者，簽署意願較高。本研究結果可提供老人照護人員對社區老人死亡態度的瞭解，並可作為未來發展老人生死教育及相關照護措施的參考，進而提升老人照護品質。[[abstract]]The purposes of the study were to understand the attitudes toward death among a group of community-dwelling elders, and to characterize their understanding on advance directives and the willingness to signing it. A cross-sectional design was used in this study. A convenient sample of 127 community-dwelling elders in Taipei city was enrolled into this study. We used a structured questionnaire for collecting the data including: demographic variables, Death Attitude Profile-Revised (DAP-R), and attitudes towards advance directives. The software, SPSS 17.0, was applied for the following statistical analysis, including descriptive statistics, Student’s t-test, one way ANOVA and chi-square test. The results showed that the mean age of the elders were 72.87 years old, more female were studied, and most of them self-reported their health status as ordinary. Among death attitudes, the score of the “Neutral acceptance” factor was the highest and the one of the “Death fear” factor was the lowest. In the factors influencing death attitudes, poor and ordinary health statuses were associated with “Death escape” and “Death fear”. The different education levels were also associated with “Neutral acceptance”. The belief of religion preferred “Approach acceptance”. Little belief of religion was related to “Death fear”. Once the people had encountered death-related experience, it seemed they had less fear of death and had more positive attitudes toward facing death. Studying the association between death attitudes and advance directives, I found the persons with the death attitudes toward “Approach acceptance” were more willing to sign an advance directive. The factors affecting willingness of the elders for advance directives included receiving the messages related to advance directives, understanding the regulations of the relevant laws, knowing that they could change the contents and decision of the advance directives at any time. The findings of this study may provide elderly care workers an understanding on elders’ attitudes towards death in the community and a reference for developing life and death education and care facilities for the elders in order to improve the quality of elderly care