论文 | 临终生活质量到死亡质量：一项针对中国老年人的回顾性队列研究

作者介绍

李婧

复旦大学人口与发展政策研究中心博士后

宋靓珺*（通讯作者）

复旦大学发展研究院助理研究员

彭希哲

复旦大学老龄研究院院长

复旦大学发展研究院常务副院长

胡湛

复旦大学老龄研究院副院长

简介

“优逝”已成为长寿社会下社会高质量发展、人民获得感提升的重要发展目标。本文基于2008 — 2018年“中国老年健康影响因素跟踪调查 (CLHLS)”死亡老人调查数据（老人死亡时间在2011年1月到2019年6月之间），分析了中国老年人临终阶段的健康状况、日常生活能力等生活质量与死亡质量的关系。通过结构方程模型的测算，实证研究的结果发现：1）临终阶段同时患有两种及以上疾病（即“多病共存”）的老人，逝世时通常较为痛苦且容易经历临终谵妄；多病共存也可能通过降低老人的日常生活能力而间接降低死亡质量。2）临终境况对死亡质量的影响在两性之间呈现不同的发展路径：相较于男性老人，女性更少受多病共存的困扰、逝世时更安详；而男性临终前的日常生活能力更强、更少遭受临终谵妄。3）相较于性别，基于城乡的死亡质量差异相对微弱：尽管离世时，农村老人比城镇老人更可能经受痛苦，但由于农村老人罹患多病共存的比例小、其逝世时反而不易发生谵妄。以上结果表明，临终生活的异质性会对死亡质量产生不同的影响。多病共存对日常功能和死亡质量的负面影响更凸显了老年人慢病管理对提升临终生活质量与死亡质量的重要作用。“关口前移、预防促进”是中国老龄化新时代健康管理的新理念。应积极培育当代老年人自我健康管理意识，激励他们继续学习自我健康管理的知识和技能。使得老年人成为健康保健的规划者和自我发展促进的参与者，还原老年人的主体性和社会性。

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

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