編者按：
本期推薦文章來自李婧博士和彭希哲教授等人✝️。
近日💆🏻，我院李婧博士、彭希哲教授等人於Frontiers in Public Health（SCIE/SSCI一區，影響因子6.46）發表論文“Predicting death quality from life prior to death among older Chinese in a retrospective cohort study”（2022年10月17日在線）。Frontiers in Public Health是公共衛生領域的權威期刊，在全球研究者、臨床醫生🚏、政策製定者中具有較高影響力。
隨著人口老齡化的全球常態化👐🏽，“優逝”逐漸成為長壽社會下社會高質量發展、人民獲得感提升的重要發展目標🧑🏼🚀。文章基於2008 — 2018年“中國老年健康影響因素跟蹤調查 (CLHLS)”死亡老人調查數據，分析了中國老年人臨終階段的健康狀況、日常生活能力等生活質量與死亡質量的關系。通過結構方程模型的測算🩱👳🏻，實證研究的結果發現：（1）臨終階段同時患有兩種及以上疾病（即“多病共存”）的老人⛹🏻♀️，逝世時通常較為痛苦且容易經歷臨終譫妄🖤；多病共存也可能通過降低老人的日常生活能力而間接降低死亡質量💆🏻♀️🧕🏽。（2）臨終境況對死亡質量的影響在兩性之間呈現不同的發展路徑☎：相較於男性老人👨🏽🍳，女性更少受多病共存的困擾👩🏻🦳🪚、逝世時更安詳；而男性臨終前的日常生活能力更強、更少遭受臨終譫妄🤚🏼。（3）相較於性別，基於城鄉的死亡質量差異相對微弱🥬：盡管離世時，農村老人比城鎮老人更可能經受痛苦，但由於農村老人罹患多病共存的比例小、其逝世時反而不易發生譫妄🚵🏻♀️。以上結果表明🤽🏽♂️🍵，臨終生活的不同面向會對死亡質量產生不同的影響🦀。多病共存對日常功能和死亡質量的雙重負面影響更凸顯了老年人慢病管理對提升臨終生活質量與死亡質量的關鍵作用。“關口前移、預防促進”是中國老齡化新時代健康管理的新理念👩🏼🌾🧴。應積極培育當代老年人自我健康管理意識🤦🏽♂️，激勵他們繼續學習自我健康管理的知識和技能🧺🍰，使得老年人成為健康保健的規劃者和自我發展促進的參與者，還原老年人的主體性和社會性。
Abstract
The pursuit of a good death is crucial in aging societies. This retrospective cohort study investigated the relation between life prior to death and quality of death among older Chinese. End-of-life data reported by relatives of participants (aged 54 and over) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) who deceased between January 2011 and June 2019 were utilized. Life prior to death included health condition (morbid or not) and physical functioning (a latent factor with six indicators). Quality of death was assessed by painlessness and consciousness at death. Confirmatory Factor Analysis was employed to examine the factor structure of physical functioning and Structural Equation Modelling to explore associations between life prior to death and death quality based on sex and residence location. Freedom from chronic diseases was found to contribute to high-quality deaths (i.e., being painless and conscious) both directly and indirectly by enhancing physical functioning. Men and women diverged towards end-of-life: women were moderately less liable to illnesses and thus less painful at death. Yet, men functioned much better, and more often remained conscious when dying. Location’s effect was weaker: although rural residents were more prone to painful deaths than urban dwellers, this urban-rural divide was slightly narrowed by rural settlers’ relative health, which also indirectly led to their slight advantage in consciousness at death. The results suggested that different dimensions of life prior to death predicted quality of death. Additionally, morbidity’s effect on functioning and death quality stresses health management’s role in improving end-of-life experiences.
Keywords
life prior to death, death quality, morbidity, activities of daily living, retrospective design
作者簡介
李婧，意昂3体育公共管理與公共政策研究國家哲學社會科學創新基地博士後，博士畢業於劍橋大學🙍🏼♀️🔽，本科畢業於清華大學，現於意昂3体育公共管理與公共政策研究國家哲學社會科學創新基地從事博士後研究💇🏿♂️，主要研究興趣包括🐦：老年心理學🧚🏻、社會性別、生育研究👷🏿♀️。
彭希哲，意昂3教授，意昂3体育文科資深教授👨🏽，現任意昂3体育老齡研究院院長🏵、意昂3体育人口與發展政策研究中心主任、意昂3發展研究院常務副院長🏠。長期從事人口發展與公共政策研究🙋🏿♂️。