Community end-of-life care among Chinese older adults living in nursing homes.

AIM: The aim of the present study was to investigate the preference and willingness-to-pay (WTP) of older Chinese adults for community end-of-life care in a nursing home rather than a hospital. METHODS: A total of 1540 older Chinese adults from 140 nursing homes were interviewed. Four hypothetical questions were asked to explore their preferences for end-of-life care. Using a discrete choice approach, specific questions explored acceptable trade-offs between three attributes: availability of doctors onsite, attitude of the care staff and additional cost of care per month. RESULTS: Approximately 35% of respondents preferred end-of-life care in the nursing home, whereas 23% of them would consider it in a better nursing home. A good attitude of staff was the most important attribute of the care site. Respondents were willing to pay an extra cost of US$5 (HK$39) per month for more coverage of doctor's time, and US$49 (HK$379) for a better attitude of staff in the nursing home. The marginal WTP for both more coverage of doctor's time and better attitude of staff amounted to US$54 (HK$418). Respondents on government subsidy valued the cost attribute more highly, as expected, validating the hypothesis that those respondents would be less willing to pay an additional cost for end-of-life care. CONCLUSIONS: Older Chinese adults living in nursing homes are willing to pay an additional fee for community end-of-life care services in nursing homes. Both the availability of the doctor and attitudes of nursing home staff are important, with the most important attribute being the staff attitudes. Geriatr Gerontol Int 2013; 14: 273-284.

Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong.

OBJECTIVES: The objectives of the present study were to describe the knowledge and preferences of Hong Kong Chinese older adults regarding advance directives and end-of-life care decisions, and to investigate the predictors of preferences for advance directive and community end-of-life care in nursing homes. METHODS: This was a cross-sectional survey conducted in 140 nursing homes in Hong Kong. A total of 1600 cognitively normal Chinese older adults were recruited. Information on demographics, social, medical diseases, preferences of end-of-life care decisions, and advance directives were collected by face-to-face questionnaire interviews. RESULTS: The mean age of the participants was 82.4 years; 94.2% of them would prefer to be informed of the diagnosis if they had terminal diseases and 88.0% preferred to have their advance directives regarding medical treatment in the future. Approximately 35% would prefer to die in their nursing homes. The significant independent predictors for the preference of advance directive included asking for relatives' advice, wishing to be informed of their terminal illness diagnoses, absence of stroke, and having no problems in self-care in European Quality of Life-5 Dimensions. For the preference for community end-of-life care and dying in nursing homes, the independent predictors included older age, not having siblings in Hong Kong, Catholic religion, nonbeliever of traditional Chinese religion, not receiving any old age allowance, lower Geriatric Depression Scale score, and being residents of government-subsidized nursing homes. CONCLUSIONS: Most of our cognitively normal Chinese nursing home older adults prefer having an advance directive, and one-third of them would prefer to die in nursing homes.