Awareness and Completion of Advance Directives in Older Korean‐American Adults

Abstract

There has been growing concerns about racial and ethnic disparities in completion rates of advance directives (ADs) among community-dwelling older populations. While differences in AD completion rates in non-Hispanic Whites and African Americans have been reported, not much is known about the awareness and completion of ADs in other groups of ethnic minorities. Using a sample of community-dwelling Korean American older adults (n = 675) as a target, factors associated with their awareness and completion of ADs were explored. Guided by Andersen's behavioral health model, predisposing (age, sex, marital status, and education), need (chronic conditions and functional disability), and enabling variables (health insurance and acculturation) were included in the separate logistic regression models of AD awareness and AD completion. In both models, acculturation was found to be a significant predictor; those who had a higher level of acculturation were more likely to be aware of ADs and to have completed ADs. This study contributes to the knowledge about the role of acculturation in explaining AD awareness and completion among Korean American older adults and provides practice implications for possible AD educational interventions for this older adult minority population.

Association between Chinese or South Asian ethnicity and end-of-life care in Ontario, Canada

“…A decedent was classified as having received palliative care if there were administrative codes for palliative care visits in outpatient, inpatient, long-term care or complex continuing care settings (Appendix 1, available at www.cmaj.ca/lookup/suppl/ doi:10.1503/cmaj.190655/-/DC1). 41 The data included home care services provided to patients given an "end-of-life" designation by their physicians, but did not include home care services provided to patients without such a designation or services paid for out of pocket by patients or families. 41…”

Correlates of advance directive treatment preferences among community‐dwelling older people with chronic diseases

“…The utilisation rates vary by healthcare context (Glaudemans et al, ), with the completion of ADs ranging from 26.3% of the general adult population aged 18 years or older in the United States (Rao, Anderson, Lin, & Laux, ) to 71% among deceased American adults (Enguidanos & Ailshire, ). Racial and ethnic disparities are also concerning; the awareness and utilisation of ADs are particularly lacking in Hispanics, African Americans and immigrant minorities, such as Korean Americans, who retain the cultural influence of their native country (Dobbs, Park, Jang, & Meng, ; Portanova, Ailshire, Perez, Rahman, & Enguidanos, ). Therefore, additional information from East Asian countries is likely to aid in developing and delivering culturally sensitive palliative and supportive care in a timely manner.…”

“…Some of the findings of earlier studies about the relationships of demographic factors with the completion or awareness of ADs were inconsistent, possibly due to different healthcare contexts, decisions or populations. For example, older age was associated with a higher rate of AD completion among American adults (Rao et al, ), community‐dwelling Korean Americans (Dobbs et al, ), and hospitalised and community‐dwelling older adults (Alano et al, ). Female gender and higher education were also common factors associated with a higher rate of AD completion (Alano et al, ).…”

“…Community‐dwelling individuals with older age, a critical medical condition and more knowledge about ACP were more likely to show willingness for an ACP discussion (NG et al, ). Some of these predisposing demographic factors (female gender, married status, higher level of education, multiple chronic conditions and having health insurance) along with acculturation also increased the likelihood of awareness among community‐dwelling Korean Americans (Dobbs et al, ). Conversely, 23.6% of patients with tumours who underwent radiotherapy already had ADs and half probably would have ADs in the future (van Oorschot, Schuler, Simon, & Flentje, ).…”

“…This study had several limitations. The sample of this study consisted predominantly of female elderly individuals; it has been previously reported that women were more likely to have greater awareness (Dobbs et al, ) or greater completion of an AD (Alano et al, ). However, gender‐specific differences in preferences for AD treatments were not observed in this female‐dominant sample, requiring validation with a more representative sample.…”