Discussion and completion of advance directives among community dwelling older adults

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Hamel, Carole F.
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Advance directives (ADs) in Manitoba are documents that allow competent individuals to set forth their medical treatment wishes and to name a health care proxy in the event that they lose the capacity to make or communicate these decisions at some time in the future. Despite the benefits of such documents and widespread support for advance planning, very few people have completed an advance directive. Using the Health Belief Model as a conceptual framework, this post-test only experimental study examined whether an individualized intervention (phone call reminder) given to half of the older adults who attended an AD educational session increased the discussion and/or completion ate of ADs. Two questionnaires (self-administered and telephone) were administered to a convenience sample of 74 older adults living in a large midwestern Canadian city, who had been randomly assigned to control and intervention groups. Of the 74 participants, 25.7% (n = 19) completed an AD. There were no significant differences between control and intervention groups on the discussion and/or completion of ADs. Both bivariate and multivariate analysis suggested a significant relationship between AD discussion and completion and perceived barriers associated with ADs. Overall, the study findings indicate a positive attitude toward advance directives and their completion, but significant barriers to discussion and completion included a present orientation, procrastination, busy lifestyles, and not thinking about one's own death. Future research is needed to explore factors influencing completion and non-completion of ADs.