Korean J Adult Nurs.  2018 Oct;30(5):527-535. 10.7475/kjan.2018.30.5.527.

Factors associated with the Decision to Withhold Life-Sustaining Treatments among Middle-Aged and Older Adults Who Die in Hospital

• Cheon J

• KMID: 2423843
• DOI: http://doi.org/10.7475/kjan.2018.30.5.527

Abstract

PURPOSE
As advanced medical care has resulted in the unintended consequence of prolonging deaths, there is a growing interest in the decision to withhold life-sustaining treatments. The purpose of this study was to determine factors associated with the decision to withhold life-sustaining treatments in middle-aged and older adults who die in hospital in the United States.
METHODS
This cross-sectional correlational study conducted secondary analysis of 2000-2012 exit interview data from the Health and Retirement Study. Adults aged 50 and older who died in hospital and who had made a decision regarding life-sustaining treatments were included. Multivariable logistic regression was used to identify factors related to the decision to withhold life-sustaining treatments.
RESULTS
Among 1,412 adults, the prevalence of the decision to withhold life-sustaining treatments was 61.1%. Significant factors associated with the decision to withhold life-sustaining treatments were being African American (Adjusted Odds Ratio [AOR]=0.50, 95% Confidential Interval [CI]=0.30~0.86), Catholic (AOR=0.5, 95% CI=0.32~0.93), having at least one private insurance policy (AOR=1.40, 95% CI=1.02~1.92), having a living will (AOR=1.71, 95% CI=1.04~2.83), and having discussed end-of-life care with someone (AOR=1.810, 95% CI=1.25~2.62).
CONCLUSION
Differences in race and religious affiliation should be considered when older adults, family members, and health care providers make decisions regarding life-sustaining treatments at the end-of-life. Also, health insurance coverage for advance care planning makes it easier for people to discuss life-sustaining treatments with health care providers.

MeSH Terms

Adult*
Advance Care Planning
Continental Population Groups
Decision Making
Health Personnel
Humans
Insurance
Insurance, Health
Life Support Care
Living Wills
Logistic Models
Odds Ratio
Prevalence
Retirement
Terminal Care
United States

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