Willingness to complete advance directives among low-income older adults living in the USA.
This study explored low-income older adults' willingness to (i) complete advance directives, legal documents, whereby an individual designates decision-makers in the event that they cannot make their own decisions about end-of-life treatment preferences, and (ii) the role of social support and other predictors that impact their willingness. This study was conducted as part of a larger study exploring behaviours of advance care planning among low-income older adults. Out of a total of 255 participants from the original study, this study included 204 participants who did not complete an advance directive for data analysis. A cross-sectional study using probability random sampling stratified by ethnicity was used. Older adults residing in two supportive housing facilities or who were members of a senior centre in San Diego, California, USA, were interviewed in person between December 2010 and April 2011. Hierarchical logistic regression analysis revealed that the majority of participants (72.1%) were willing to complete advance directives and the factors significantly predicting willingness to complete included self-rated health, attitudes towards advance decision-making and social support. Participants with a poorer health status (OR = 1.43, 95% CI = 1.07-1.90) were more willing to complete advance directives. Conversely, participants with higher positive attitudes (OR = 1.18, 95% CI = 1.00-1.39) and greater social support (OR = 1.07, 95% CI = 1.00-1.15) were also more willing to complete advance directives. The findings suggest the importance of ongoing support from healthcare professionals in end-of-life care planning. Healthcare professionals can be a source of support assisting older adults in planning end-of-life care. Initiating ongoing communication regarding personal value and preference for end-of-life care, providing relevant information and evaluating willingness to complete as well as assisting in the actual completion of advance directives will be necessary.
School of Social Work, San Diego State University, San Diego, California, USA.
Eunjeong
E
Ko
Institute for Measurement, Methodology, Analysis and Policy, Texas Tech University, Lubbock, Texas, USA. jaehoon.lee@ttu.edu.
Jaehoon
J
Lee
Department of Family Welfare, Sangmyung University, Seoul, Korea.
Youngjoon
Y
Hong
D000328:Adult; D032722:Advance Care Planning; D016223:Advance Directives; D002140:California; D003430:Cross-Sectional Studies; D006801:Humans; D011203:Poverty
advance directives; low income; older adults; social support; willingness