Factors Affecting Living Will Interest among Older People: A Cross-Sectional Study at a Tertiary Care Hospital in Bangkok, Thailand
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Abstract
Introduction: A living will is a legal document that enables patient-centered care when patients become incapacitated or incompetent towards the end of life. Living will interest in older people has been understudied in the Thai population. The aim of this study is to evaluate the association between psychosocial characteristics and living will interest in older adults at the Comprehensive Geriatrics Clinic, King Chulalongkorn Memorial Hospital, Bangkok.
Method: We conducted a cross-sectional study on older adults (age ≥ 60 years) who visited the Comprehensive Geriatrics Clinic between 2020 and 2023, using data collected by geriatric nurses through structured interviews consisting of demographic data and questionnaires about personal life and living will. Multivariable logistic regression with backward stepwise elimination was used to identify the associated factors of high living will interest. The odds ratio (OR) was calculated for each of these factors.
Results: There were 4,676 older adults. The majority were female (76.6%), aged 60-69 years (67.0%), Buddhist (96.1%), and university graduates (69.8%). The prevalence of high living will interest was 19.5%. Determinants of high living will interest included demographic factors, such as being female (OR=1.24), older age (OR=1.02), unmarried (OR=1.29), and university graduates (OR=1.74); well-being factors, such as having high life satisfaction (OR=1.33), getting adequate exercise (OR=1.78) or dietary fiber (OR=1.31), and suffering from high physical (OR=1.48) or mental distress (OR=1.54); and death-awareness factors, such as knowing someone who has made a living will (OR=2.94), having witnessed severe illness in family or close friends (OR=2.32), and having attended introspective activities held by the Comprehensive Geriatrics Clinic (OR=6.70).
Conclusion: Living will interest among older people was low. Psychosocial factors promoting well-being and death awareness generally resulted in higher living will interest. Policy makers should collaborate with healthcare providers to develop interventions that foster living will interest in the aging population.
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