Home and Community Care Digest
Despite the potential advantages of end-of-life planning, current end-of-life planning practices are lacking. This study assessed five factors to determine their relative influence on each of following three forms of end-of-life planning: living will, appointed durable power of attorney for health care, and informal discussions about one's health care preferences. Hospitalization, personal beliefs, and direct experiences with end-of-life issues are significant predictors of end-of-life planning. Suggestions on how health care providers may encourage end-of-life preparations were provided.
Background: Despite the potential advantages of end-of-life planning, the current use of end-of-life planning practices is limited. Less than 50% of older adults have a living will and end-of-life preparations tend to occur too late to be effective. This study explored 3 additional factors that may affect end-of-life preparations for community dwelling young-old adults, namely health care encounters, personal beliefs, and direct experience with others' deaths.
Methods: The following predictors of end-of-life planning were evaluated to determine their influence on end-of-life preparations: 1) recent hospitalizations; 2) personal beliefs (i.e. fear of death or desire to make their own health care decisions); 3) direct experiences with end-of-life issues; 4) socio-demographic characteristics; and 5) having informal discussions on these issues. The study sample was a randomly selected sub-sample from a large database that followed people over time. The sample completed telephone interviews and self-administered mail questionnaires twice in 1992 and 2004. Three forms of end-of-life preparations were observed: whether one 1) had a living will; 2) had a durable power of attorney for health care; and 3) had held discussions about end-of-life preparations.
Findings: Socio-demographic characteristics and informal discussion were associated with the adoption of only one of the three practices. Persons who had been hospitalized in the year prior to interview were more likely than those who had not been hospitalized to have engaged in each of the three forms of planning. Persons who believed that physicians rather than themselves should make decisions about health care and those with greater death anxiety were less likely to have engaged in end-of-life planning. Having survived the painful death of a loved one was a significant predictor of all three types of end-of-life planning. Holding informal discussions was the most powerful predictor of making formal preparations.
Conclusions: Predictors that were found to be associated with a lower chance of engaging in end-of-life planning (i.e. death anxiety and lack of desire to make health care decisions) are potentially modifiable. Thus, targeted interventions can be initiated to help this specific group. Support and education could be given to assuage people's death anxiety and to foster people's decision-making autonomy. Health care providers can effectively encourage end-of-life preparations in a number of ways, such as launching discussion groups about recent deaths of loved ones or promoting communication between older adults and their families. Finally, because of individuals' unique needs, health professionals should not limit themselves to one standardized approach to end-of-life planning for everyone.
Reference: Carr D, Khodyakov, D. "End-of-life health care planning among young-old adults: An assessment of psychosocial influences." The Journals of Gerontology 2007; 62B(2): S135-S141.
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