Correlates of advance directive treatment preferences among community-dwelling older people with chronic diseases.
Int J Older People Nurs
; 14(2): e12229, 2019 Jun.
Article
em En
| MEDLINE
| ID: mdl-30821917
ABSTRACT
BACKGROUND:
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.OBJECTIVES:
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.METHODS:
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.RESULTS:
Older people (N = 112, mean age = 74.9 years, 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).CONCLUSION:
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. IMPLICATIONS FOR PRACTICE 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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Doença Crônica
/
Diretivas Antecipadas
/
Preferência do Paciente
/
Casas de Saúde
Tipo de estudo:
Guideline
/
Prognostic_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
Asia
Idioma:
En
Revista:
Int J Older People Nurs
Assunto da revista:
ENFERMAGEM
/
GERIATRIA
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Coréia do Sul