地域在住高齢者のアドバンス・ケア・プランニング（ACP）の実施状況と関連要因：横断研究

Exploring Factors of Advance Care Planning Practice among Community-dwelling Independent Older Adults: A Cross-sectional Study

要旨

　目的：地域高齢者のアドバンス・ケア・プランニング（ACP）実施状況と関連要因を探索した．

　方法：高齢者向け地域活動に参加した65歳以上の地域高齢者380名にACP実施状況（ACPに関する話し合い及び記録）等を尋ねる自記式質問紙調査を実施した．ACP実施状況の関連要因を多重ロジスティック回帰分析にて検討した．

　結果：131名（有効回答率34.5％）のうち，ACPに関する話し合いは83名（63.4％），記録は31名（23.7％）が実施していた．話し合いには介護経験有（オッズ比（OR）：5.2，95％信頼区間（CI）：1.9〜13.9）と記録実施（OR：7.3，95％CI：1.4〜37.1）が関連した．記録には終末期に自宅療養の希望有（OR：3.6，95％CI：1.3〜9.7）と話し合い実施（OR：12.9，95％CI：2.7〜61.6）が関連した．

　結論：介護経験者を先達としてACPに関する話し合いの機会を設けるなどの支援プログラムが求められる．

　Aim: This study explored factors of advance care planning (ACP) practice among communitydwelling independent older adults.

　Method: An anonymous self-administrated questionnaire survey on ACP practice (i.e., discussing and recording on their ACP preference) was conducted with community-dwelling older adults aged 65 years or above who attended senior community activities. Multiple logistic regression analysis was performed to explore the factors associated with ACP practice.

　Results: A total of 131 questionnaires were analyzed (effective response rate: 34.5%). For ACP practice, 83 participants reported having discussed (63.4%) and 31 participants, recorded (23.7%) their preferences. Factors of ACP discussion were caregiving experience (Odds Ratio (OR): 5.2, 95% Confidence Interval (CI): 1.9-13.9), and ACP recording (OR: 7.3, 95%CI: 1.4-37.1). Factors of ACP recording were preference of staying at home at the end of life (OR: 3.6, 95%CI: 1.3-9.7), and ACP discussion (OR: 12.9, 95%CI: 2.7-61.6).

　Conclusion: Only two thirds of the participants discussed and one fourth recorded on ACP. Providing occasions discuss ACP with those experienced in family caregiving may be needed to further promote ACP practice.