Factors influencing older adults to complete advance directives

Gloria J. Alano, Renee Pekmezaris, Julia Y. Tai, Mohammed J. Hussain, Jose Jeune, Betina Louis, Gabriel El-Kass, Muhammad S. Ashraf, Roopika Reddy, Martin Lesser, Gisele P. Wolf-Klein

Research output: Contribution to journalArticlepeer-review

109 Scopus citations


Objective: The purpose of this study was to determine the factors which influence advance directive (AD) completion among older adults.Method: Direct interviews of hospitalized and community-dwelling cognitively intact patients>65 years of age were conducted in three tertiary teaching settings in New York. Analysis of AD completion focused on its correlation with demographics, personal beliefs, knowledge, attitudes, and exposure to educational media initiatives. We identified five variables with loadings of at least 0.30 in absolute value, along with five demographic variables (significant in the univariate analyses) for multiple logistic regression. The backward elimination method was used to select the final set of jointly significant predictor variables.Results: Of the 200 subjects consenting to an interview, 125 subjects (63%) had completed ADs. In comparing groups with and without ADs, gender (p<0.0002), age (p<0.0161), race (p<0.0001), education (p<0.0039), and religion (p<0.0104) were significantly associated with having an AD. Factors predicting AD completion are: thinking an AD will help in the relief of suffering at the end of life, (OR 76.3, p<0.0001), being asked to complete ADs/ or receiving explanation about ADs (OR 55.2, p<0.0001), having undergone major surgery (OR 6.3, p<0.0017), female gender (OR 11.1, p<0.0001) and increasing age (76-85 vs. 59-75: OR 3.4, p<0.0543;<85 vs. 59-75: OR 6.3, p<0.0263).Significance of results: This study suggests that among older adults, the probability of completing ADs is related to personal requests by health care providers, educational level, and exposure to advance care planning media campaigns.

Original languageEnglish (US)
Pages (from-to)267-275
Number of pages9
JournalPalliative and Supportive Care
Issue number3
StatePublished - Sep 2010
Externally publishedYes


  • Advance directives
  • Beliefs and Attitudes
  • Knowledge

ASJC Scopus subject areas

  • General Nursing
  • Clinical Psychology
  • Psychiatry and Mental health


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