%0 Journal Article
%T Older Adults Making End of Life Decisions: An Application of Roy's Adaptation Model
%A Weihua Zhang
%J Journal of Aging Research
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/470812
%X Purpose. The purpose of this study was to identify variables that influenced completion of advanced directives in the context of adaptation from national data in older adults. Knowledge gained from this study would help us identify factors that might influence end of life discussions and shed light on strategies on effective communication on advance care planning. Design and Method. A model-testing design and path analysis were used to examine secondary data from 938 participants. Items were extracted from the data set to correspond to variables for this study. Scales were constructed and reliabilities were tested. Results. The final path model showed that physical impairment, self-rated health, continuing to work, and family structure had direct and indirect effects on completion of advanced directives. Five percent of the variance was accounted for by the path analysis. Conclusion. The variance accounted for by the model was small. This could have been due to the use of secondary data and limitations imposed for measurement. However, health care providers and families should explore patient¡¯s perception of self-health as well as their family and work situation in order to strategize a motivational discussion on advance directive or end of life care planning. 1. Introduction Those aged 65 and older represented 35.9 million or 12.3% of the US population in 2003, and this number will reach 19% by the year 2030 [1]. The great majority of deaths (80¨C85%) occur in this population, and most die from chronic conditions such as heart failure, cancer, obstructive pulmonary disease, diabetes, Alzheimer¡¯s disease, and renal failure [2]. The Institute of Medicine (IOM) noted that while technology continues to increase life expectancy, the quality of life of dying patients has not kept the same pace [3]. Studies indicate that patients¡¯ families are still dissatisfied with end of life care [4¨C7]. Advance directives (ADs) were seen as a way for individuals to decide on and communicate their end of life care wishes to those who care for them to ensure, more in a legal term, that individuals¡¯ wishes for end of life care are followed. ADs include durable power of attorney and a living will. However, more than 2 decades after passage of the 1991 Patient Self-Determination Act (PSDA) requiring AD discussion on admission to health care institutions, the rate of completion of ADs remains at approximately 29% of the population [8]. Advance care planning is starting to replace the term ¡°advance directives¡± to make its slow transitioning from a legal model to a tool to enhance
%U http://www.hindawi.com/journals/jar/2013/470812/