Factors influencing attitudes toward advance directives in Korean older adults

We aimed to determine the factors influencing attitudes toward advance directives in Korean older adults with consideration of an Asian cultural background.

We recruited community-dwelling older adults aged 60 years or older at a regional senior welfare center in Korea. Demographic factors and mental and physical health status were examined using questionnaires and a physical examination. The questionnaire also assessed perceived necessity of advance directives and related experiences.

Most participants (79.32%) agreed that advance directives were necessary. Older adults with high education levels (odds ratio [OR] 2.31, 95% confidence interval [CI] 0.84-6.34), low economic status (OR 2.09, 95% C.I. 0.60-7.27), and poor cognitive function (adjusted odds ratio [aOR] 2.10, 95% CI 0.89-4.97) had a greater odds of agreeing that advance directives are necessary. All participants with self-care problems (9/9) and most participants with at risk status of physical functioning (13/14) reported agreement. Death-related experiences were also associated. Notably, individuals who had discussions on end-of-life care with family members showed a greater odds of agreeing that advance directives are necessary (aOR 2.12, 95% CI 0.88-5.11).

The factors associated with increased agreement that advance directives are necessary were high education level, low economic status, poor cognitive function, problems in self-care, poor physical functioning, death-related experiences. Especially, discussions of end-of-life care with family members increased the agreement. Thus, discussion on end-of-life care should be encouraged and the factors influencing older adults' attitudes toward advance directives should be considered in developing policies for such discussion.