关键词: 老年人保健服务, 社区卫生服务, 慢性病, 预先指示, 影响因素分析

Abstract: Background　The prevalence of chronic disease in the elderly is increasing with the accelerating process of aging in China. The development of short- and long-term complications of chronic diseases，may seriously affect these patients' ability of communication and decision-making in medical affairs. Therefore，it is essential for them to timely make an advance care plan to state their needs clearly. Objective　To investigate the preference and influencing factors of making an advance care plan in community-dwelling elderly patients with chronic diseases. Methods　From October 2019 to January 2020，280 community-dwelling elderly chronic disease patients were selected from Jinzhou by convenient sampling method. The Demographic Data Questionnaire developed by our research group，Elderly Death Attitude Scale（EDAS），Modified Barthel Index and Patient's Advance Care Planning Acceptance（PACP） Questionnaire were used to investigate them. Multiple linear regression analysis was used to analyze the factors associated with the acceptance of advance care planning. Results　271 valid questionnaires were collected，and the effective recovery rate was 96.8%. The average scores of EDAS，activities of daily living and PACP in the respondents were （73.42±12.96），（83.99±21.07） and（66.20±8.31），respectively. Escape-oriented death acceptance dimension（r=-0.206，P<0.001） and death escape dimension（r=-0.260，P<0.001） were negatively correlated with ACP acceptance，while natural acceptance dimension（r=0.303，P<0.001） was positively correlated with ACP acceptance. Activities of daily living（r=-0.361，P<0.001） was negatively correlated with ACP acceptance. Multiple linear regression analysis showed that the acceptance of ACP was 73.740 + 1.602 × education level-0.234 × escape-oriented death acceptance + 0.673 × natural acceptance-0.403 × death escape-0.141 × activities of daily living. Conclusion　The acceptance of ACP in elderly patients with chronic diseases in community was above the middle level. Death attitude and activities of daily living were the important factors influencing the acceptance of ACP. In addition to providing medical and health services to elderly patients with chronic diseases，community medical workers should also give them ACP-related health education via oral form，brochures and posters to improve their overall awareness of ACP. Neighborhood committees and social work groups can regularly give lectures on death education and hospice care to these patients to make them have a positive attitude towards death and an effective understanding of hospice care，thereby improving their acceptance of ACP.

Key words: Health services for the aged, Community health services, Chronic diseases, Advanced directives, Root cause analysis