Feasibility of the Korean-Advance Directives Among Community-Dwelling Elderly Persons

Abstract

A newly developed Korean-Advance Directive (K-AD) consists of a value statement, treatment directives, and proxy appointment. It remains undetermined whether K-AD is applicable to community-dwelling persons (≥ aged 60 years). Using a descriptive study design, 275 elderly persons completed the K-AD (mean age = 77.28 ± 8.24 years). The most frequent value at the end of life was comfort dying, followed by no burden to family (23.6%). Among 4 K-AD treatment options, more than half had a preference for hospice care and had reluctance with aggressive treatment choices of cardiopulmonary resuscitation (76.4%), artificial ventilation (75.6%), and tube feeding (76.4%), with one-fifth having a desire for such options. All persons provided proxies, who were predominantly descendants (77.1%), followed by spouses (17.5%). For treatment preferences, men and those with no religion were more likely to receive life-sustaining treatments. These data support the K-AD as being applicable and acceptable among community-dwelling elderly persons; awareness of the K-AD in the community setting may facilitate future application when the need occurs.

Attitudes toward advance directives and prognosis in patients with heart failure: a pilot study

“…Further, a larger study is warranted to assess the demographic and clinical characteristics of patients to increase the awareness and documentation of ADs in Korea. The specific responses to each component of the K-AD model in the patients with HF were similar to those of other Korean populations with and without cancer [23,33], particularly those of community-dwelling elderly individuals [23]. Comfortable death (31.8%) and reluctance to burden the family with their care (13.6%) were highly valued among the patients with HF.…”

“…In other studies in Korea, CPR was less preferred by patients with cancer-caregiver dyads (20.5% vs. 27.3%) and artificial ventilation (20.5% vs. 36.4%) [33]. In community-dwelling elderly individuals, CPR (23.3%) and artificial ventilation (24.0%) were similarly selected [23]. Further, elderly Americans who had documented AD preferences were more likely to receive limited care, as indicated by their preference, than those without ADs [32].…”

“…Comfortable death (31.8%) and reluctance to burden the family with their care (13.6%) were highly valued among the patients with HF. Among the community-dwelling elderly individuals in Korea, 35% valued comfortable death the most, and 28.6% valued no burden to the family [23]. Also, comfortable death (57.9%) and no burden to the family (24.3%) were valued by healthy adults.…”

“…The K-AD model was a measure of an AD, which was developed to explore EOL values, treatment directives, and preferred surrogate decision-makers [22,23]. For the personal value statement, the patients were asked to state their EOL values freely.…”

Psychometric Testing of the Korean Version of the Attitudes toward the Advance Directives in Low-Income Chronically Ill Older Adults

“…Although patient autonomy perseveres, family members are largely surrogate decision-makers upon the provision of one's palliative care and/or EOL medical care [51,52]. Under Confucian-rooted traditions, family members, particularly descendants, are actively engage in decision-making for patients' EOL care [53,54], while patients-even those with terminal cancer-are often excluded from the loop of EOL discussion [55,56]. Older adults in this study may have perceived two questions as giving up on a patient or negligence in such a healthcare environment, leading to inconsistent item behavior.…”