Factors influencing older adults to complete advance directives

Authors:
  • RPRenee Pekmezaris
    Renee Pekmezaris
  • JTJulia Y. Tai
    Julia Y. Tai
  • MHMohammed J. Hussain
    Mohammed J. Hussain
  • JJJose Jeune
    Jose Jeune
  • BLBetina Louis
    Betina Louis
  • GEGabriel El-Kass
    Gabriel El-Kass
  • MAMuhammad S. Ashraf
    Muhammad S. Ashraf
  • RRRoopika Reddy
    Roopika Reddy
  • MLMartin Lesser
    Martin Lesser
  • GWGisele P. Wolf-Klein
    Gisele P. Wolf-Klein
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Abstract
Objective: The purpose of this study was to determine the factors which influence advance directive (AD) completion among older adults.Method: 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 (76–85vs.59–75: OR 3.4,p < 0.0543; vs. 59–75: OR 6.3,p < 0.0263).Significance of results: 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.

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