Correlates of advance directive treatment preferences among community-dwelling older people with chronic diseases.

Abstract

Concerns over the creation of advance directives (ADs) and the factors associated with treatment directive decisions among Korean community-dwelling older people with chronic diseases have rarely been addressed. This study aimed to examine knowledge, attitudes and barriers/benefits regarding ADs and their associations with AD treatment preferences among chronically ill, low-income, community-dwelling older people. Using a descriptive, correlational design, older people who were recipients of home visiting service for chronic disease management participated in this study. Home visiting nurses collected data on knowledge, attitudes and perceived barriers/benefits and treatment directives using questionnaires during home visits. Older people (N=112, mean age=74.9years, women=83.9%) who had chronic diseases such as hypertension (56.3%), diabetes mellitus (40.2%) and cardiovascular disease/stroke (22.3%) participated. Approximately half of the participants preferred hospice care (54.5%), while a few of them preferred aggressive treatments: cardiopulmonary resuscitation (CPR) (14.3%), ventilation support (9.8%) and haemodialysis (8.9%). Being married was associated with the likelihood of preferring CPR (odds ratio [OR]=11.79) and ventilation support (OR=9.99), higher education with CPR (OR=1.23) and haemodialysis (OR=1.16), and having a cardiovascular disease (CVD)/stroke with CPR (OR=6.46) and hospice care (OR=3.06). Among the modifiable factors, greater perceived barriers increased the likelihood of CPR preference (OR=1.12) but decreased the likelihood of hospice care preference (OR=0.96). Greater perceived benefits decreased the likelihood of CPR preference (OR=0.81) and ventilation support (OR=0.89), and AD knowledge decreased the likelihood of haemodialysis preference (OR=0.23). The multidimensional factors were differently associated with each of the AD treatment preferences. Modifiable factors, including perceived barriers and benefits and knowledge, should be improved to help low-income, community-dwelling older people select adequate AD treatment preferences. Additional information regarding AD treatments and some modifiable and non-modifiable correlates can be integrated into primary and palliative/supportive care in public health. The current home visitation service may also benefit from incorporating AD discussions while extending the service to embrace AD issues in addition to disease management.