Factors during senescence that prevent advance decision-making regarding AHN / 日本プライマリ・ケア連合学会誌

ABSTRACT

<b>Purpose</b> This study aimed to explore the factors which interfere with advance decision-making with regards to artificial hydration and nutrition (AHN) in the senescent population.<br><b>Methods</b> Subjects were local residents aged 60 years or older who were leading an independent life and who could go out by themselves. A cross-sectional study using a self-administered questionnaire was conducted from August to November 2011. Valid responses were obtained from 116 subjects, for a valid response rate of 90.6%. Advance AHN decisions, knowledge about AHN, intentions regarding advance directives and end-of-life care, experience providing long-term care, in addition to other questions, were analyzed using a multiple logistic regression model.<br><b>Results</b> With respect to advance decisions regarding AHN, 25 respondents (21.6%) indicated that they could not make a decision, while 91 respondents (78.4%) could. Sixteen respondents (13.8%) desired some component of AHN, while 75 respondents (64.7%) did not desire any AHN. Factors related to difficulty with advance decisions regarding AHN were 1) lack of adverse experiences associated with decreased cognitive function (“experience of failure”) (OR=12.0, 95%CI=1.42-100.41, p<.022), 2) lack of experience providing long-term care for a family member (“experience of caring”) (OR=3.0, 95%CI=1.04-8.53, p<.042), and 3) desire to defer such decisions to others in the event of unconsciousness or other incompetency rather than an advance decision (“reliance on others”) (OR=5.6, 95%CI=1.95-16.24, p<.001).<br><b>Conclusion</b> Factors related to difficulty with advance decisions regarding AHN in the senescent population were lack of adverse experiences associated with decreased cognitive function, lack of experience providing long-term care for a family member, and desire to defer such decisions to others in the event of unconsciousness or other incompetency rather than an advance decision.