Paper
Thursday, July 22, 2004
Factors Related to Supporting Advance Directives Among the Elderly in Japan
Miho Matsui, RN, PHN, MS, Gerontological Nursing, Faculty of Health Sciences, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan and Michiko Moriyama, RN, MSN, PhD, Prof, Clinical Nursing, Institute of Health Sciences, Faculty of Medicine, Hiroshima University, Hiroshima, Japan.
| Learning Objective #1: Understand the elderly person's knowledge and preference for advance directives |
| Learning Objective #2: Discuss the importance of self-determination for terminal care of the elderly using advance directives |
Objective: Advance directive is not a legal document in Japan. Medical staff or family, therefore, often confronts the situation that patient preference for medical treatment in the terminal stage is unclear. Thus, the purpose of this study was to examine factors related to supporting advance directives among the Japanese elderly. Design: A cross-sectional study using a structured questionnaire. Sample: 565 Senior Citizens' Club members in Hiroshima (urban city, poplation is one million) and Ube city (rural city,one hundred and seventy thousand) received a questionnaire, 336 of them (59.5%) responded, a valid response rate of 55.4%. Method: The data for this study were demographic, health and medical status, preference for terminal care, personal values such as autonomy, family function, attitude towards religion and death. Findings: 72.9% supported advance directives, 54.9% of them agreed to legalization. Regression analysis was used after analyzing factors which were significant in each category, recognition of living wills, refusal to receive mechanical respiration in terminal stage, strong attitudes towards religion and positive capacity of death were related factors. In recognition of living wills, 10.9% were familiar with living wills, 70.5% had heard about them, 18.7% had never heard. Preference for mechanical respiration was 13.9% want to receive this treatment, 44.3% rely on their physician's judgment, 13.2% prefer to rely on family decision-making, and 28.6% did not want to receive it. Conclusion: 72.9% elderly supported advance directives, and factors related to them were their knowledge about living wills, preference for life-sustaining treatment, their personal values concerning religion and death. Implication: Public education for the elderly regarding medical care of end of life stage is necessary as to help their decision-making of life-sustaining activities and making a valid statement/documentation of person's wishes such as living wills, and also to promote discussion about advance directives.
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