Korean J Adult Nurs.  2016 Jun;28(3):334-342. 10.7475/kjan.2016.28.3.334.

Factors Influencing Self Determination for Withdrawing Life-Sustaining Treatment of the Community Dwelling Elderly

• Kim HS
• Jang HK
• Shin SR

• KMID: 2312166
• DOI: http://doi.org/10.7475/kjan.2016.28.3.334

Abstract

PURPOSE
This study was conducted to identify factors that influence on self-determination for withdrawal of life-sustaining treatment in the community dwelling elderly.
METHODS
This study used a descriptive correlational design. A convenience sample of 201 elderly were recruited from a welfare center located in Seoul, Korea. Data collection was done from September 1 to September 18, 2015. Four survey questionnaires were used: Multidimensional Scale of Perceived Social Support (MSPSS), Life Satisfaction Index-Z (LSI-Z), Attitude on Do Not Resuscitate (DNR), and Self-determination for Withdrawing Life-sustaining Treatment. Data analysis was done by t-test, ANOVA, Pearson's correlation, and hierrarchical multiple regression.
RESULTS
Hierarchial multiple regression showed that the factors predicting the level of self-determination for withdrawing life-sustaining treatment were educational level, DNR experience in family, life satisfaction, and DNR attitude. These factors explained 44% of the self-determination for withdrawing life-sustaining treatment in community dwelling elderly.
CONCLUSION
The results of this study suggest developing educational programs aiming at changing elderly's DNR attitude positive ways so that they can enhance self-determination for withdrawing life-sustaining treatment. Further study is needed with more elderly population in extended areas.

MeSH Terms

Aged*
Data Collection
Humans
Independent Living*
Korea
Personal Autonomy*
Seoul
Statistics as Topic

Reference

1. Statistics Korea. Elderly statistics 2015 [Internet]. Daejeon: Ministry of Health & Welfare, Statistics Korea;2015. Cited 2016 June 19. Available from: http://kostat.go.kr/portal/eng/pressReleases/1/index.board?bmode=read&aSeq=349205.

2. Korea Statistical Information Service. 2014 Senior survey: number of chronic diseases in the elderly (over 65 years). Seoul: Ministry of Health & Welfare, Korea Statistical Information Service;2014. Cited 2016 July 5. Available from: http://kosis.kr/statHtml/statHtml.do?orgId=117&tblId=DT_11771_2011N035&conn_path=I3.

3. Kim HR, Oh KS, Oh KO, Lee SO, Lee SO, Lee SJ, et al. Quality of life in low income Korean aged. J Korean Acad Nurs. 2008; 38(5):694–703. DOI: 10.4040/jkan.2008.38.5.694.

4. Choe JY, Kim HC. A patient's right of self-determination for withdrawal of the life-sustaining treatment; court case review. Bioeth Policy Stud. 2009; 3(2):155–172.

5. Jeun YJ. Right of informed concent and withdrawing of life-sustaining treatment. Law Rev. 2009; 33:455–476.

6. Kim HS, Shin SR. The effect of educational program on withdrawing life-sustaining treatment for elderly. J Korea Acad Ind Coop Soc. 2015; 16(1):397–407. DOI: 10.5762/KAIS.2015.16.1.397.

7. Park YO. Experience of family members on deciding to withdraw life-sustaining treatment for patients who are terminally ill. Paper presented at: The meeting of Korean Society of Nursing Science. 2004 May; Seoul.

8. Han NY, Yoon HJ, Park EW, Cheong YS, Yoo SM. Perception of a good death in the elderly. J Korean Acad Fam Med. 2002; 23(6):769–777.

9. Kim KS. Application of advance directives at a general hospital [master's thesis]. Ulsan: University of Ulsan;2010.

10. Lee MH. The effects of ego integrity trait of elderly persons on life-sustaining treatment preferences. J Digit Converg. 2016; 14(2):489–499. DOI: 10.14400/JDC.2016.14.2.489.

11. Chang CY, Kim YS. Attitude toward forgoing life-sustaining treatment among cancer patient families. Korean Acad Mental Health Soc Work. 2011; 38:5–30.

12. Carmel S, Mutran EJ. Stability of elderly persons' expressed preferences regarding the use of life-sustaining treatments. Soc Sci Med. 1999; 49(3):303–311. DOI: 10.1016/S0277-9536(99)00121-5.

13. Ko EJ, Lee JH. End-of-life treatment preference among low-income older adults: a race/ethnicity comparison study. J Health Care Poor Underserved. 2014; 25(3):1021–1033.

14. Kim ES. Perception and ethical attitude about withdrawing of life-sustaining treatments f or the elderly between elderly patients and their family. [master's thesis]. Jeonju: Chonbuk National University;2012.

15. Yoon MS, Kim JS. Factors to the withdrawing of life sustaining treatment among low income elderly. Korea Acad Mental Health Soc Work. 2015; 43(3):192–219.

16. Chung SD, Kim SH, Koo MJ. The relationship between death related factors and death preparation: a comparison of pre-elderly and babyboomers. Korea J Popul Stud. 2014; 37(1):131–153.

17. Garrido MM, Balboni TA, Maciejewski PK, Bao Y, Prigerson HG. Quality of life and cost of care at the end of life: the role of advance directives. J Pain Symptom Manage. 2015; 49(5):828–835. DOI: 10.1016/j.jpainsymman.2014.09.015.

18. Gerstel E1, Engelberg RA, Koepsell T, Curtis JR. Duration of withdrawal of life support in the intensive care unit and association with family satisfaction. Am J Respir Crit Care Med. 2008; 178(8):798–804. DOI: 10.1164/rccm.200711-1617OC.

19. Kim YS. Attitude of death perception on hospice and attitudes of DNR by nursing students in an area. Korean J Health Serv Manag. 2014; 8(3):219–228. DOI: 10.12811/kshsm.2014.8.3.219.

20. Lee HK, Kang HS. Attitudes and awareness towards the withdrawal of life-sustaining treatment among nurses, physicians, and families of intensive care unit patients. J Korean Clin Nurs Res. 2010; 16(3):85–98.

21. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess. 1988; 52(1):30–41. DOI: 10.1207/s15327752jpa5201_2.

22. Shin JS, Lee YB. The effects of social supports on psychosocial well-being of the unemployed. Korean J Soc Welf. 1999; (37):241–269.

23. Neugarten BL, Havighurst RJ, Tobin SS. The measurement of life satisfaction. J Gerontol. 1961; 6(1):134–143. DOI: 10.1093/geronj/16.2.134.

24. Lee CE. A study on the relation ship between perception of sex life and life satisfaction in elderly [master's thesis]. Seoul: Hanyang University;1999.

25. Korean Medical Association. Korean Academy of Medical Sciences. Korean hospital association. Guidelines on withdrawing life-sustaining therapy. Seoul: Special Committee Established Guidelines on Withdrawing Life-Sustaining Therapy;2009. p. 1–10.

26. Lee YS. Ministry of Health & Welfare. Research Affairs of Seoul National University. Survey of the people's understanding on withdrawal of life-sustaining management and proposal of its legislation. Seoul: Ministry of Health & Welfare;2009. p. 1–360.

27. Fortner BV, Neimeyer RA. Death anxiety in older adults: a quantitative review. Death Stud. 1999; 23(5):387–411.

28. Sun DS, Chun YJ, Lee JH, Gil SH, Shim B, Lee OK, et al. Recognition of advance directives by advanced cancer patients and medical doctors in hospice care ward. Korean J Hosp Palliat Care. 2009; 12(1):20–26.

29. Bettinghaus EP, Cody MJ. Persuasive communication. 5th ed. NY: Wadswort Publishing;1994. p. 432.

30. Seo YS, Son YL, Sung KW. Factors related to the death attitudes among the elderly women in rural areas. J Korean Gerontol Nurs. 2011; 13(1):21–28.