Completion of Advance Directives Among Low-Income Older Adults

Ko, Eunjeong; Lee, Jae‐Hoon

doi:10.1177/1049909113486170

Cited by 58 publications

(84 citation statements)

References 40 publications

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“…, Johnson et al . , Ko & Lee , ). This may mean that there are other factors widening an ethnic difference in actual AD completion such as availability and accessibility to AD information and opportunities to discuss ADs in the healthcare setting.…”

Section: Discussionmentioning

confidence: 99%

Willingness to complete advance directives among low-income older adults living in the USA

Lee

Hong

2015

Health Soc Care Community

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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.

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Section: Discussionmentioning

confidence: 99%

Willingness to complete advance directives among low-income older adults living in the USA

Lee

Hong

2015

Health Soc Care Community

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“…Johnson and colleagues have reported that racial differences in advance directive possession are no longer significant after adjustment for cultural beliefs and values, sampling 205 older adults recruited from one university health center; Ko and Lee have reported that Latino-white differences in advance directive possession are explained by differences in knowledge, sampling 256 older adults from the same urban area. 10,11 Carr reported that black-white differences in advance directive possession are limited to those of low socioeconomic status, although this national sample of 2111 adults was limited to those in stable romantic partnerships (potentially screening for high socioeconomic status and more conservative cultural values). 22 In our study, participants who reported Catholic and Evangelical religious affiliations were less likely than mainline Protestants to have advance directives, even after adjusting for personal health values.…”

Section: Discussionmentioning

confidence: 99%

“…On this alternative hypothesis, race and ethnicity are merely proxies for cultural beliefs and religious values that influence individuals' willingness to undertake advance care planning. 10,11 In support of this hypothesis, black and Hispanic Americans are more likely than white Americans to say religion is very important in their lives 6,10 and black Americans are more likely to endorse the statement that their health outcomes are determined by God. 12,13 Furthermore, whereas advance directives are often used to limit life-sustaining treatment, black and Hispanic Americans are more likely to desire life-sustaining treatment despite poor prognosis.…”

Section: Introductionmentioning

confidence: 95%

“…12,13 Furthermore, whereas advance directives are often used to limit life-sustaining treatment, black and Hispanic Americans are more likely to desire life-sustaining treatment despite poor prognosis. 6,14,15 Recent investigators examining associations among race/ ethnicity, cultural values, and advance directive possession in non-representative convenience samples have reached conflicting conclusions 6,10,11 ; to date, these relationships have not been evaluated in large, demographically representative samples. In this study, we investigated whether racial and ethnic differences in advance directive possession are explained by other demographic factors, religious characteristics, and personal health values, using a nationally representative sample of older U.S. adults.…”

Section: Introductionmentioning

confidence: 99%

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Racial and Ethnic Differences in Advance Directive Possession: Role of Demographic Factors, Religious Affiliation, and Personal Health Values in a National Survey of Older Adults

Huang

Neuhaus

Chiong

2016

Journal of Palliative Medicine

106

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Background: Black and Hispanic older Americans are less likely than white older Americans to possess advance directives. Understanding the reasons for this racial and ethnic difference is necessary to identify targets for future interventions to improve advance care planning in these populations. Methods: The aim of the study was to evaluate whether racial and ethnic differences in advance directive possession are explained by other demographic factors, religious characteristics, and personal health values. A general population survey was conducted in a nationally representative sample using a web-enabled survey panel of American adults aged 50 and older (n = 2154). Results: In a sample of older Americans, white participants are significantly more likely to possess advance directives (44.0%) than black older Americans (24.0%, p < 0.001) and Hispanic older Americans (29.0%, p = 0.006). Gender, age, retired or disabled employment status, educational attainment, religious affiliation, Internet access, preferences for physician-centered decision making, and desiring longevity regardless of functional status were independent predictors of advance directive possession. In fully adjusted multivariable models with all predictors included, black older Americans remained significantly less likely than white older Americans to have an advance directive (odds ratio [OR] = 0.42, 95% confidence interval [CI] = 0.24-0.75), whereas the effect of Hispanic ethnicity was no longer statistically significant (OR = 0.65, 95% CI = 0.39-1.1). Conclusion: In a nationally representative sample, black race is an independent predictor for advance directive possession. This association remains even after adjustment for other demographic variables, religious characteristics, and personal health values. These findings support targeted efforts to mitigate racial disparities in access to advance care planning.

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“…However, despite advanced care planning education efforts, completion of ADs is relatively low, with only one third to one half of older adults completing ADs (Ko & Lee, 2014). Clinicians encounter and support clients and their families with the associated comorbidities of aging and the loss of social networks.…”

Section: Resultsmentioning

confidence: 98%

Promoting Advance Directives and Ethical Wills With the HIV-Aging Cohort by First Assessing Clinician Knowledge and Comfort Level

Martín

2015

Journal of the Association of Nurses in AIDS Care

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Completion of Advance Directives Among Low-Income Older Adults

Cited by 58 publications

References 40 publications

Willingness to complete advance directives among low-income older adults living in the USA

Willingness to complete advance directives among low-income older adults living in the USA

Racial and Ethnic Differences in Advance Directive Possession: Role of Demographic Factors, Religious Affiliation, and Personal Health Values in a National Survey of Older Adults

Promoting Advance Directives and Ethical Wills With the HIV-Aging Cohort by First Assessing Clinician Knowledge and Comfort Level

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