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Brief Report| Volume 22, ISSUE 2, P344-348, February 2021

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Advance Directive Completion and Its Associated Factors Among Older Chinese Americans

Published:August 04, 2020DOI:https://doi.org/10.1016/j.jamda.2020.06.049

      Abstract

      Objectives

      To examine the factors of advance directive (AD) completion among older Chinese Americans.

      Design

      Cross-sectional survey.

      Setting and Participants

      Data came from 435 Chinese Americans aged 55 years and older living in 2 metropolitan areas through self-administered questionnaires and research assistant–administered interviews in 2018. Participants' average age was 75 years (standard deviation = 9.4).

      Methods

      Logistic regression was used to examine factors associated with AD completion.

      Results

      Approximately 14% of participants completed an AD. Older age [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.02-1.12], higher level of acculturation (OR 2.15, 95% CI 1.39-3.33), higher expectation for intergenerational support (OR 1.52, 95% CI 1.02-2.27), and having US citizenship (OR 3.02, 95% CI 1.26-7.23) were positively associated with AD completion. Physical and mental health needs were not significantly associated with AD completion.

      Conclusions and Implications

      This study is among the first focusing on AD completion among Chinese Americans, one of the fastest-growing older minority populations in the United States. Findings highlight the influence of socioeconomic and cultural factors on AD completion and illustrate the importance of developing culturally sensitive interventions to promote end-of-life care decision making among older Chinese Americans.

      Keywords

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      References

        • Sudore R.L.
        • Fried T.R.
        Redefining the “planning” in advance care planning: Preparing for end-of-life decision making.
        Ann Intern Med. 2010; 153: 256-261
        • Klingler C.
        • In Der Schmitten J.
        • Marckmann G.
        Does facilitated advance care planning reduce the costs of care near the end of life? Systematic review and ethical considerations.
        Palliat Med. 2016; 30: 423-433
        • Carr D.
        • Luth E.A.
        Advance care planning: Contemporary issues and future directions.
        Innov Aging. 2017; 1: 1-10
        • Rao J.K.
        • Anderson L.A.
        • Lin F.C.
        • Laux J.P.
        Completion of advance directives among U.S. consumers.
        Am J Prev Med. 2014; 46: 65-70
        • Hickman R.L.
        • Pinto M.D.
        Advance directives lessen the decisional burden of surrogate decision-making for the chronically critically ill.
        J Clin Nurs. 2014; 23: 756-765
        • Jang Y.
        • Park N.S.
        • Chiriboga D.A.
        • et al.
        The knowing-doing gap in advance directives in Asian Americans: The role of education and acculturation.
        Am J Hosp Palliat Care. 2017; 34: 874-879
        • Gao X.
        • Sun F.
        • Ko E.
        • et al.
        Knowledge of advance directive and perceptions of end-of-life care in Chinese-American elders: The role of acculturation.
        Palliat Support Care. 2015; 13: 1677-1684
        • Pew Research Center
        Chinese in the U.S. fact sheet. 2019.
        (Available at:)
        • Glanz K.
        • Bishop D.B.
        The role of behavioral science theory in development and implementation of public health interventions.
        Annu Rev Public Health. 2010; 31: 399-418
        • Andersen R.
        • Newman J.F.
        Societal and individual determinants of medical care utilization in the United States.
        Milbank Mem Fund Q Health Soc. 1973; 51: 95-124
        • Rosnick C.B.
        • Reynolds S.L.
        Thinking ahead: Factors associated with executing advance directives.
        J Aging Health. 2003; 15: 409-429
        • Rurup M.L.
        • Onwuteaka-Philipsen B.D.
        • Van Der Heide A.
        • et al.
        Frequency and determinants of advance directives concerning end-of-life care in the Netherlands.
        Soc Sci Med. 2006; 62: 1552-1563
        • Dobbs D.
        • Park N.S.
        • Jang Y.
        • Meng H.
        Awareness and completion of advance directives in older Korean-American adults.
        J Am Geriatr Soc. 2015; 63: 565-570
        • Gupta R.
        • Yick A.G.
        Preliminary validation of the acculturation scale on Chinese Americans.
        J Soc Work Res Eval. 2001; 2: 43-56
        • Koenig H.G.
        • Büssing A.
        The Duke University Religion Index (DUREL): A five-item measure for use in epidemological studies.
        Religions. 2010; 1: 78-85
        • Daatland S.O.
        • Herlofson K.
        • Lima I.A.
        Balancing generations: On the strength and character of family norms in the West and East of Europe.
        Ageing Soc. 2011; 31: 1159-1179
        • Olson D.H.
        Circumplex Model VII: Validation studies and FACES III.
        Fam Process. 1986; 25: 337-351
        • Kocalevent R.D.
        • Zenger M.
        • Hinz A.
        • et al.
        Resilient coping in the general population: Standardization of the Brief Resilient Coping Scale (BRCS).
        Health Qual Life Outcomes. 2017; 15: 251
        • Katz S.
        Assessing Self-maintenance: Activities of daily living, mobility, and instrumental activities of daily living.
        J Am Geriatr Soc. 1983; 31: 721-727
        • Kessler R.C.
        • Andrews G.
        • Colpe L.J.
        • et al.
        Short screening scales to monitor population prevalences and trends in non-specific psychological distress.
        Psychol Med. 2002; 32: 959-976
        • Royston P.
        • White I.R.
        Multiple imputation by chained equations (MICE): Implementation in Stata.
        J Stat Softw. 2011; 45: 1-20
        • Ko E.
        • Lee J.
        Completion of advance directives among Korean American and Non-Hispanic White older adults.
        Res Aging. 2010; 32: 618-644
        • Kossman D.A.
        Prevalence, views, and impact of advance directives among older adults.
        J Gerontol Nurs. 2014; 40: 44-50
        • Hopp F.P.
        Preferences for surrogate decision makers, informal communication, and advance directives among community-dwelling elders: Results from a national study.
        Gerontologist. 2000; 40: 449-457
        • Judy Campbell M.
        • Jo Edwards M.
        • Ward K.S.
        • Weatherby N.
        Developing a parsimonious model for predicting completion of advance directives.
        J Nurs Scholarsh. 2007; 39: 165-171
        • Ko E.
        • Lee J.
        Completion of advance directives among low-income older adults: Does race/ethnicity matter?.
        Am J Hosp Palliat Med. 2014; 31: 247-253
        • Gerst K.
        • Burr J.A.
        Planning for end-of-life care: Black-white differences in the completion of advance directives.
        Res Aging. 2008; 30: 428-449
        • Carr D.
        Racial differences in end-of-life planning: Why don’t Blacks and Latinos prepare for the Inevitable?.
        OMEGA J Death Dying. 2011; 63: 1-20
        • Lee M.C.
        • Byon H.D.
        • Hinderer K.
        • Alexander C.
        Beliefs in advance care planning among Chinese Americans: Similarities and differences between the younger and older generations.
        Asian/Pacific Isl Nurs J. 2017; 2: 83-90
        • Yonashiro-Cho J.
        • Cote S.
        • Enguidanos S.
        Knowledge about and perceptions of advance care planning and communication of Chinese-American older adults.
        J Am Geriatr Soc. 2016; 64: 1884-1889