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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: [email protected]
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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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