Abstract
Objectives. To investigate the preferences of ACP and healthcare autonomy in community-dwelling older Chinese adults. Methods. A community-based cross-sectional study was conducted with older adults living in the residential estate of Chaoyang District, Beijing. Results. 900 residents were enrolled. 80.9% of them wanted to hear the truth regarding their own condition from the physician; 52.4% preferred to make their own healthcare decisions. Only 8.9% of them preferred to endure life-prolonging interventions when faced with irreversible conditions. 78.3% of the respondents had not heard of an ACP; only 39.4% preferred to document in an ACP. Respondents with higher education had significantly higher proportion of having heard of an ACP, as well as preferring to document in an ACP, compared to those with lower education. Those aged <70 years had higher proportion of having heard of an ACP, as well as refusing life-prolonging interventions when faced with irreversible conditions, compared to those aged ≥70 years. Conclusions. Although the majority of community-dwelling older Chinese adults appeared to have healthcare autonomy and refuse life-prolonging interventions in terms of end-of-life care, a low level of “Planning ahead” awareness and preference was apparent. Age and education level may be the influential factors.
Highlights
The provision of optimum care for the aging population is dependent on the understanding of their views and values on healthcare issues, especially end-of-life issues
When introduced to the concept of Advance care planning (ACP), the majority (78.3%) of them had not heard of it, and only 39.4% wanted to document in an ACP, whereas 41.9% did not. 18.7% of the respondents refused to answer this question
This study was the first attempt to investigate community-dwelling older persons’ preferences and attitudes towards ACP, truth telling, healthcare autonomy, and end-of-life care, as well as explore the factors associated with those attitudes in mainland China
Summary
The provision of optimum care for the aging population is dependent on the understanding of their views and values on healthcare issues, especially end-of-life issues. ACP generally takes one of two forms: (1) the advance directive or “living will,” a mechanism that allows individuals to catalog their preferences for future healthcare; (2) the durable power of attorney for healthcare or “healthcare proxy,” a document that assigns a surrogate to make medical decisions on behalf of a patient in the event of decisional incapacitation [2]. It has gained prominence internationally for perceived benefits in enhancing patient autonomy and ensuring that patients receive appropriate, high-quality end-of-life care, as well as reducing stress, anxiety, and depression in surviving family members [3]. Up to 70% of community-dwelling older adults in the United
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