关键词: 预先指示, 社区卫生服务, 老年人, 家属, 认知, 态度, 影响因素分析

Abstract: Background　Community-dwelling elderly residents are a key group for the use of advance directives. Understanding the knowledge and attitudes regarding advance directives among these residents and families helps to promote the use of advance directives. Objective　To explore the knowledge and attitudes regarding advance directives and associated factors among community-dwelling elderly residents and their families. Methods　This survey was carried out from November to December 2019 using the Demographic Information Questionnaire developed by our research group，Knowledge of Advance Directives Scale（KADS） and Attitudes Towards Advance Directives Scale（AADS）. Participants were elderly residents（n=200） and family members（n=200） selected from 10 communities in Tanggu Street，Binhai New Area of Tianjin. Results　170 questionnaires were collected from the elderly residents in the community and 180 questionnaires were collected from family members. The median scores of KADS for older residents and their families were 0（0，0），0（0，0），respectively. The rates of knowing advance directives for older residents and family members were 6.5%（11/170） and 10.6%（19/180），respectively. The rates of accepting advance directives for older residents and family members were 41.2%（70/170） and 58.9%（106/180），respectively. Stepwise Logistic regression analysis showed that education level，whether to give up treatment and valuing quality of life or survival time when the conditions are difficult to be reversed or at the late stage of the disease，and prevalence of hearing about advance directives were independently associated with the acceptance of advance directives in the older residents（P<0.05）. And education level，living style with the elderly, and knowledge of advance directives，opinion of whether use of symptomatic treatment when the condition is difficult to be reversed or at the late stage of the disease，and prevalence of hearing about living will were independently associated with the acceptance of advance directives in familie members（P<0.05）. Conclusion　The levels of knowledge of advance directives among these community-dwelling elderly residents and familiee members are quite low，and their acceptances of advance directives need to be improved. In view of this，related education for them should be strengthened via the propaganda of advance directives by community medical and nursing care workers.

Key words: Advance directive, Community health services, Aged, Family members, Cognition, Attitude, Root cause analysis