title: Factors influencing older adults to complete advance directives.
abstract: OBJECTIVE
  The purpose of this study was to determine the factors which influence advance directive (AD) completion among older adults.
  
  
  METHODS
  Direct interviews of hospitalized and community-dwelling cognitively intact patients > 65 years of age were conducted in three tertiary teaching settings in New York. Analysis of AD completion focused on its correlation with demographics, personal beliefs, knowledge, attitudes, and exposure to educational media initiatives. We identified five variables with loadings of at least 0.30 in absolute value, along with five demographic variables (significant in the univariate analyses) for multiple logistic regression. The backward elimination method was used to select the final set of jointly significant predictor variables.
  
  
  RESULTS
  Of the 200 subjects consenting to an interview, 125 subjects (63%) had completed ADs. In comparing groups with and without ADs, gender (p < 0.0002), age (p < 0.0161), race (p < 0.0001), education (p < 0.0039), and religion (p < 0.0104) were significantly associated with having an AD. Factors predicting AD completion are: thinking an AD will help in the relief of suffering at the end of life, (OR 76.3, p < 0.0001), being asked to complete ADs/ or receiving explanation about ADs (OR 55.2, p < 0.0001), having undergone major surgery (OR 6.3, p < 0.0017), female gender (OR 11.1, p < 0.0001) and increasing age (76-85 vs. 59-75: OR 3.4, p < 0.0543; < 85 vs. 59-75: OR 6.3, p < 0.0263).
  
  
  CONCLUSIONS
  This study suggests that among older adults, the probability of completing ADs is related to personal requests by health care providers, educational level, and exposure to advance care planning media campaigns.
authors.affiliation: North Shore Long Island Jewish Health System, New Hyde Park, New York 11040, USA. gloriajmd@yahoo.com
authors.forename: Gloria J
authors.initials: GJ
authors.lastname: Alano
authors.forename: Renee
authors.initials: R
authors.lastname: Pekmezaris
authors.forename: Julia Y
authors.initials: JY
authors.lastname: Tai
authors.forename: Mohammed J
authors.initials: MJ
authors.lastname: Hussain
authors.forename: Jose
authors.initials: J
authors.lastname: Jeune
authors.forename: Betina
authors.initials: B
authors.lastname: Louis
authors.forename: Gabriel
authors.initials: G
authors.lastname: El-Kass
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Ashraf
authors.forename: Roopika
authors.initials: R
authors.lastname: Reddy
authors.forename: Martin
authors.initials: M
authors.lastname: Lesser
authors.forename: Gisele P
authors.initials: GP
authors.lastname: Wolf-Klein
mesh_terms: D032722:Advance Care Planning; D016223:Advance Directives; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D004522:Educational Status; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009518:New York; D010358:Patient Participation; D012737:Sex Factors