Factors associated with living will among older persons receiving long-term care in Finland

Abstract

Background: A living will document is known to be an important tool for preparing for future care together with healthcare professionals. A living will supports an older person’s self-determination and autonomy. Only a few studies have approached the underlying factors of a living will document among older long-term care recipients. Objectives: To explore how common having a living will was among older persons receiving home care or round-the-clock long-term care, as well as to evaluate associations between socio-demographical factors and functional capacity with a living will. Design: The study population consisted of older persons receiving long-term care in Finland in 2016–2017. Data were collected via individual assessments at home or at a care facility. The questions in the assessment covered health, functional capacity, service use, and social support. Methods: Primary outcome ‘living will’ and associated factors were identified for each person aged 65 or older from RAI-assessment data (Resident Assessment Instrument, RAI). Cross-tabulations with χ²-tests and adjusted binary logistic regression models were performed to evaluate the association between the factors and a living will. Results: Of the 10,178 participants, 21% had a living will – a greater proportion were female (22%) than male (18%), and a greater proportion of residents in assisted living (25%) and residential care homes (20%) compared with home care residents (15%) had a living will. Female gender ( p < 0.001), having a proxy decision-maker ( p = 0.001), increasing age ( p = 0.003), impairing functional capacity (activities of daily living hierarchy p < 0.001, Cognitive Performance Scale p < 0.001), instability of health status (Changes in Health, End-Stage Disease and Signs and Symptoms p < 0.001), and closeness of death ( p < 0.001) were significantly associated with a living will among older persons. Extensive differences in results were found between home care clients and clients of round-the-clock long-term care. Conclusion: Preparedness for the future with a living will varies according to services and on individual level. To reduce inequalities in end-of-life care, actions for advance care planning with appropriate timing are warranted.