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本期推荐文章来自李婧博士和彭希哲教授等人。
近日，我院李婧博士、彭希哲教授等人于Frontiers in Public Health（SCIE/SSCI一区，影响因子6.46）发表论文“Predicting death quality from life prior to death among older Chinese in a retrospective cohort study”（2022年10月17日在线）。Frontiers in Public Health是公共卫生领域的权威期刊，在全球研究者、临床医生、政策制定者中具有较高影响力。
随着人口老龄化的全球常态化，“优逝”逐渐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。文章基于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，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，临终生活的不同面向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双重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关键作用。“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
作者简介
李婧，复旦大学公共管理与公共政策研究国家哲学社会科学创新基地博士后，博士毕业于剑桥大学，本科毕业于清华大学，现于复旦大学公共管理与公共政策研究国家哲学社会科学创新基地从事博士后研究，主要研究兴趣包括：老年心理学、社会性别、生育研究。
彭希哲，复旦大学社会发展与公共政策学院教授，复旦大学文科资深教授，现任复旦大学老龄研究院院长、复旦大学人口与发展政策研究中心主任、复旦发展研究院常务副院长。长期从事人口发展与公共政策研究。