积极老龄化视角下失智老人意愿决策困境与优化路径研究

Challenges and Optimization Paths of Decision-Making Autonomy among Older Adults with Dementia: An Active Ageing Perspective

摘要: 在实践中，失智老人常被视为被动接受照护的对象，其主体性和自主意愿容易在家庭照护、机构照护及制度运行过程中被忽视甚至消解。基于积极老龄化理念，本文认为失智并不等同于主体性的消失，失智老人仍保有一定程度的价值判断能力、情感表达能力和自主意愿。文章以积极老龄化理论、主体性理论和支持性决策理论为分析框架，从沟通障碍、家庭替代决策、外部支持缺位以及制度保障不足四个方面分析失智老人意愿决策面临的现实困境，并进一步探讨其形成原因及解决思路，以期实现对失智老人主体价值和决策自主权的充分尊重，促进积极老龄化目标的实现。

Abstract: In contemporary care practices, older adults with dementia are often regarded as passive recipients of care, whose subjectivity and autonomous wishes are frequently overlooked in family care, institutional care, and social support systems. Drawing on the concept of active ageing, this paper argues that dementia does not signify the loss of subjectivity; rather, older adults with dementia retain varying degrees of evaluative judgment, emotional expression, and autonomous will. Based on the theoretical framework of active ageing, subjectivity, and supported decision-making, the paper examines the practical challenges facing their decision-making autonomy from four dimensions: communication barriers, family-substituted decision-making, inadequate external support, and insufficient institutional safeguards. It further analyzes the underlying causes of these challenges and proposes corresponding improvement measures. The study aims to promote respect for the subjective value and decision-making autonomy of older adults with dementia and to contribute to the realization of active ageing objectives.