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Factors influencing older adults to complete advance directives

Published online by Cambridge University Press:  27 September 2010

Gloria J. Alano ,
Renee Pekmezaris ,
Julia Y. Tai ,
Mohammed J. Hussain ,
Jose Jeune ,
Betina Louis ,
Gabriel El-Kass ,
Muhammad S. Ashraf ,
Roopika Reddy  and
Martin Lesser
...Show all authors
Gloria J. Alano*
Affiliation:
North Shore Long Island Jewish Health System, New Hyde Park, New York
Renee Pekmezaris
Affiliation:
North Shore Long Island Jewish Health System, New Hyde Park, New York The Bette and Jerome Lorber Center for the Advancement of Medical Education, New Hyde Park, New York
Julia Y. Tai
Affiliation:
The Feinstein Institute for Medical Research, Manhasset, New York
Mohammed J. Hussain
Affiliation:
North Shore Long Island Jewish Health System, New Hyde Park, New York
Jose Jeune
Affiliation:
North Shore Long Island Jewish Health System, New Hyde Park, New York
Betina Louis
Affiliation:
North Shore Long Island Jewish Health System, New Hyde Park, New York
Gabriel El-Kass
Affiliation:
North Shore Long Island Jewish Health System, New Hyde Park, New York
Muhammad S. Ashraf
Affiliation:
North Shore Long Island Jewish Health System, New Hyde Park, New York
Roopika Reddy
Affiliation:
North Shore Long Island Jewish Health System, New Hyde Park, New York
Martin Lesser
Affiliation:
The Feinstein Institute for Medical Research, Manhasset, New York
Gisele P. Wolf-Klein
Affiliation:
North Shore Long Island Jewish Health System, New Hyde Park, New York The Bette and Jerome Lorber Center for the Advancement of Medical Education, New Hyde Park, New York
*
Address correspondence and reprint requests to: Gloria J. Alano, North Shore Long Island Jewish Health System, Division of Geriatrics, 270-05 76th Avenue, New Hyde Park, NY 11040. E-mail: gloriajmd@yahoo.com
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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 (76–85 vs. 59–75: OR 3.4, p < 0.0543; <85 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.

Keywords

Advance directivesKnowledgeBeliefs and Attitudes
Type
Original Articles
Information
Palliative & Supportive Care , Volume 8 , Issue 3 , September 2010 , pp. 267 - 275
Copyright
Copyright © Cambridge University Press 2010

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References

REFERENCES

Baker, M.E. (2002). Economic, political and ethnic influences on end-of-life decision making: A decade in review. Journal of Health and Social Policy, 14, 27–39.CrossRefGoogle ScholarPubMed
Bayer, W., Mallinger, J.B., Krishnan, A., et al. (2006). Attitudes toward life-sustaining interventions among ambulatory black and white patients. Ethnicity and Disease, 16, 914–919.Google ScholarPubMed
Braun, K.L., Onaka, A.T. & Horiuchi, B.Y. (2001). Advance directive completion rates and end-of-life preferences in Hawaii. Journal of the American Geriatrics Society, 49, 708–713.CrossRefGoogle ScholarPubMed
Bravo, G., Dubois, M.F. & Wagneur, B. (2008). Assessing the effectiveness of interventions to promote advance directives among older adults: A systematic review and multi-level analysis. Social Science and Medicine, 67, 1122–1132.CrossRefGoogle ScholarPubMed
Bullock, K. (2006). Promoting advance directives among African Americans: A faith based model. Journal of Palliative Medicine, 9, 182–195.CrossRefGoogle ScholarPubMed
Campbell, M.J., Edwards, M.J., Ward, K.S., et al. (2007). Developing a parsimonious model for predicting completion of advance directives. Journal of Nursing Scholarship, 39, 165–171.CrossRefGoogle ScholarPubMed
Eleazer, G.P., Hornung, C.A., Egbert, C.B., et al. (1996). The relationship between ethnicity and advance directives in a frail older population. Journal of the American Geriatrics Society, 44, 938–943.CrossRefGoogle Scholar
Foti, M.E., Bartels, S.J., Van Citters, A.D., et al. (2005). End-of-life treatment preferences of persons with serious mental illness. Psychiatric Services, Washington D.C., 56, 585–591.CrossRefGoogle ScholarPubMed
Gordon, N.P. & Shade, S.B. (1999). Advance directives are more likely among seniors asked about end-of-life care preferences. Archives of Internal Medicine, 159, 701–704.CrossRefGoogle ScholarPubMed
Hanson, L.C. & Rodgman, E. (1996). The use of living wills at the end-of-life. A national study. Archives of Internal Medicine, 9, 1018–1022.CrossRefGoogle Scholar
Hinkka, H., Kosunen, E., Metsanoja, R., et al. (2002). Factors affecting physicians' decisions to forgo life-sustaining treatments in terminal care. Journal of Medical Ethics, 28, 109–114.CrossRefGoogle ScholarPubMed
Hopp, F.P. (2000). Preferences for surrogate decision makers, informal communication, and advance directives among community-dwelling elders: Results from a national study. Gerontologist, 40, 449–457.CrossRefGoogle ScholarPubMed
Kwak, J. & Salmon, J.R. (2007). Attitudes and preferences of Korean-American older adults and caregivers on end-of-life care. Journal of the American Geriatrics Society, 55, 1867–1872.CrossRefGoogle ScholarPubMed
Lindner, S.A., Davoren, J.B., Vollmer, A., et al. (2007). An electronic medical record intervention increased nursing home advance directive orders and documentation. Journal of the American Geriatrics Society, 55, 1001–1006.CrossRefGoogle ScholarPubMed
Llovera, I., Ward, M.F., Ryan, J.G., et al. (1999). Why don't emergency department patients have advance directives? Academic Emergency Medicine, 6, 1054–1060.CrossRefGoogle ScholarPubMed
Maxfield, C.L., Pohl, J.M. & Colling, K. (2003). Advance directives: A guide for patient discussions. The Nurse Practitioner, 28, 38–47.CrossRefGoogle ScholarPubMed
McAdam, J.L., Stotts, N.A. & Padilla, G. (2005). Attitudes of critically ill Filipino patients and their families toward advance directives. American Journal of Critical Care. 14, 17–25.CrossRefGoogle ScholarPubMed
Mebane, E.W., Oman, R.F., Kroonen, L.T., et al. (1999). The influence of physician race, age, and gender on physician attitudes toward advance care directives and preferences for end-of-life decision-making. Journal of the American Geriatrics Society, 47, 579–591.CrossRefGoogle ScholarPubMed
Mezey, M.D., Leitman, R., Mitty, E.L., et al. (2000). Why hospital patients do and do not execute an advance directive? Nursing Outlook, 48, 165–171.CrossRefGoogle Scholar
Morrison, R.S. & Meier, D. (2004) High rates of advance care planning in New York City's elderly population. Archives of Internal Medicine, 164, 2421–2426.CrossRefGoogle ScholarPubMed
Morrison, R.S., Chinchin, E., Carter, J., et al. (2005). The effect of a social work intervention to enhance advance care planning documentation in the nursing home. Journal of the American Geriatrics Society, 53, 290–294.CrossRefGoogle ScholarPubMed
Morrison, R.S., Morrison, E.W. & Glickman, D.F. (1994). Physician reluctance to discuss advance directives. An empiric investigation of potential barriers. Archives of Internal Medicine, 24, 2311–2318.CrossRefGoogle Scholar
Morrison, R.S., Zayas, L.H., Mulvihill, M., et al. (1998). Barriers to completion of health care proxies: An examination of ethnic differences. Archives of Internal Medicine, 158, 2493–2497.CrossRefGoogle ScholarPubMed
Murphy, S.T., Palmer, J.M., Azen, S., et al. (1996). Ethnicity and advance care directives. Journal of Law, Medicine and Ethics, 24, 108–117.CrossRefGoogle ScholarPubMed
Nicolasora, N., Pannala, R., Mountantonakis, S., et al. (2006). If asked, hospitalized patients will choose whether to receive life-sustaining therapies. Journal of Hospital Medicine, 1, 161–167.CrossRefGoogle ScholarPubMed
Perry, E., Swartz, J., Brown, S., et al. (2005). Peer mentoring: A culturally sensitive approach to end-of-life planning for long-term care dialysis patients. American Journal of Kidney Diseases, 46, 111–119.CrossRefGoogle ScholarPubMed
Phipps, E., True, G., Harris, D., et al. (2003). Approaching the end of life: Attitudes, preferences, and behaviors of African-American and white patients and their family caregivers. Journal of Clinical Oncology, 21, 549–554.CrossRefGoogle ScholarPubMed
Puchalski, C.M., Zhong, Z., Jacobs, M.M., et al. (2000). Patients who want their family and physician to make resuscitation decisions for them: Observations from SUPPORT and HELP. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. Hospitalized Elderly Longitudinal Project. Journal of the American Geriatrics Society, 48 (5 Suppl), S84–S90.CrossRefGoogle ScholarPubMed
Ramsaroop, S.D., Reid, M.C. & Adelman, R.D. (2007). Completing an advance directive in the primary care setting: What do we need for success? Journal of the American Geriatrics Society, 55, 277–283.CrossRefGoogle ScholarPubMed
Reilly, B.M., Wagner, M., Magnussen, C.R., et al. (1995). Promoting inpatient directives about life-sustaining treatments in a community hospital. Results of a 3-year time-series intervention trial. Archives of Internal Medicine, 155, 2317–2323.CrossRefGoogle Scholar
Singer, P.A., Martin, D.K. & Kelner, M. (1999). Quality end-of-life care: patients' perspectives. Journal of the American Medical Association, 281, 163–168.CrossRefGoogle ScholarPubMed
Sonnenblick, M., Friedlander, Y. & Steinberg, A. (1993). Dissociation between the wishes of terminally ill parents and decisions by their offspring. Journal of the American Geriatrics Society, 41, 599–604.CrossRefGoogle ScholarPubMed
The SUPPORT principal investigators. (1995). A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatment (SUPPORT). Journal of the American Medical Association, 274, 1591–1598.CrossRefGoogle Scholar
Troyer, J.L. & McAuley, W.J. (2006). Environmental contexts of ultimate decisions: Why white nursing home residents are twice as likely as African American residents to have an advance directive. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 61, S194–S202.CrossRefGoogle ScholarPubMed
Wallace, M.P., Weiner, J.S., Pekmezaris, R., et al. (2007). Physician cultural sensitivity in African American advance care planning: A pilot study. Journal of Palliative Medicine, 10, 721–727.CrossRefGoogle ScholarPubMed
Zapka, J.G., Carter, R., Carter, C.L., et al. (2006). Care at the end of life: Focus on communication and race. Journal of Aging and Health, 18, 791–813.CrossRefGoogle ScholarPubMed
Zweibel, N.R. & Cassel, C.K. (1989). Treatment choices at the end of life: A comparison of decisions by older patients and their physician-selected proxies. Gerontologist, 29, 615–621.CrossRefGoogle ScholarPubMed