JAMDA Advance Directive and End-of-Life Care Preferences Among Nursing Home Residents in Wuhan , China : A Cross-Sectional Study

ome re predic l surve han, M home r Objectives: To describe Chinese nursing h life care preferences and to explore the Design: Population-based cross-sectiona Settings: Nursing homes (n 1⁄4 31) in Wu Participants: Cognitively intact nursing Measures: Face-to-face questionnaire interview chronic diseases, life-sustaining treatment, AD Results: Most (95.3%) had never heard of AD, an More than half (52.5%) would receive life-su condition. Fewer than one-half (43.3%) chos sustaining treatment, whereas most (78.8%) n More than half (58.2%) wanted to live and di pendent predictors of AD preference included h definite answers of receiving (OR 3.433) or re Cumulative Illness Rating Scale score (OR 1.098 Conclusions: Most nursing home residents did n attitudes toward it. AD should be promoted in m maker, and nursing home staff on AD is very im guidelines about AD should be made with fl mainland China. The authors declare no conflicts of interest. This study was funded by the Fundamental Res Universities, Huazhong University of Science and Tec ber: 2012QN206). uth or' s c op y sidents’ knowledge of advance directive (AD) and end-oftors of their preference for AD. y. ainland Southern China. esidents (n 1⁄4 467) older than 60 years. s were used to collect information on demographics, , and other end-of-life care preferences. d fewer than one-third (31.5%) preferred to make an AD. staining treatment if they sustained a life-threatening e doctors as the surrogate decision maker about lifeominated their eldest son or daughter as their proxy. e in their present nursing homes. The significant indeaving heard of AD before (odds ratio [OR] 9.323), having jecting (OR 2.530) life-sustaining treatment, and higher ). ot know about AD, and nearly one-third showed positive ainland China. Education of residents, the proxy decision portant. Necessary policy support, legislation, or practice exibility to respect nursing home residents’ rights in A With the aging of China’s population, the demand for nursing homes.6 Although nursing home residents are frailer than those living home care is increasing.1 In Wuhan, a southern city in Hubei province, Mainland China, there are approximately 9.79 million people.2 The number of people older than 65 years in China is projected to increase from its current level of 8.9%3 to 23.0% by 2050.4 Although few (1.49%) older people currently live in nursing homes in mainland China,4 it is anticipated that a combination of China’s “4-2-1” (1-child policy) or “4-2-2” (some couples can have 2 children if only 1 or neither of the pair has siblings) family structure and industrialization5 will see larger numbers of older people moving into nursing earch Funds for the Central hnology (project grant numin their own homes,6 few studies have investigated the end-of-life care preferences of older Chinese people living in nursing homes.7 A recent study involving older Chinese people living in Hong Kong nursing homes found that most did not desire cardiopulmonary resuscitation (CPR) (61%) or artificial nutrition or hydration (74%) to be initiated.7 Another Hong Kong study identified that many nursing home residents were uncertain or uncomfortable when asked about stating their preferences for life-sustaining treatment, with many leaving this question unanswered.6 In traditional Chinese culture, death is a very sensitive issue, and a topic to be avoided, with those who do mention death considered sacrilegious.8 Most older Chinese people consult their relatives, especially their oldest son, before making health care decisions. For example, traditional Taiwanese believe their eldest son is responsible for arranging the rest of their life.9 In a rapidly developing country like China, it is challenging to integrate traditional values and advance care planning processes into the existing health care system.