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Learning Objective 1: The learner will be able to understand how family members’ interest and view of end-of-life could impact on elders’ completion of advance directives.
Learning Objective 2: The learner will be able to examine cultural influences on interpretation of end-of-life and advance directives.
Methods: The literature addressed advance directives, family, aged 65+years, community health services, and published in English and/or Japanese between 2001 and 2011 were included for a systematic review.
Results: The total 35 studies meeting inclusion criteria were reviewed. Their subjects were mainly from Japan, US, and UK. In any cultures, family members’ interest and view of end-of-life strongly affected the completion rates and contents of advance directives among elders. Japanese elders did not feel right to include their family members when they considered their end-of-life options. They believed that talking about end-of-life could distance and disappoint their family. End-of-life care options should be determined by their family, not by themselves. American and English elders had more positive attitudes toward advance directives, though its completion rate has still been low. It was believed that advance directives would become psychological support for their family when it is needed. It could also be a communication tool to discuss about end-of-life issues among family members.
Conclusion: In any cultures, family plays a significant role for elders’ completing advance directives. When there is adequate education about advance directives and following active discussions including elders, their family members, and health care professionals, there would be a higher completion rate of advance directives. Cultural differences were seen in the role of family members when elders considered advance directive. The future research should investigate to establish culturally sensitive educational sessions on advance directives for their elderly clients and their family.