Analysis of middle-aged and older adults’ willingness concerning living wills and associated factors

TL;DR

This study explores how willing middle-aged and older adults in Shenzhen are to create living wills and what factors influence their willingness.

Contribution

The study identifies nine factors associated with willingness to create living wills among middle-aged and older adults in China.

Findings

64.7% of participants showed positive willingness toward creating a living will.

Factors like education, social support, and health status significantly influence willingness.

Religious belief and witnessing medical events also play a role in willingness.

Abstract

To investigate the current status of Living Will willingness among middle-aged and older adults in Shenzhen, China, and to systematically identify its associated influencing factors.

Based on the Theory of Planned Behavior and the Life Course Theory, a cross-sectional survey was conducted from May 2023 to February 2024. A total of 519 middle-aged and older adults were recruited in Shenzhen. Data were collected using a general information questionnaire, a Living Will knowledge questionnaire, a Living Will attitude scale, a family APGAR scale, a health status scale, and a social support scale. Chi-square test, Mann–Whitney U test, and Firth penalized logistic regression analysis were employed to identify associated factors.

The proportion of participants with a positive willingness toward creating a Living Will was 64.7%. Significant influencing factors included age (p = 0.033), being a healthcare professional (p = 0.033), being a civil servant or employee of a public institution/enterprise (p = 0.033), experience of witnessing a rescue or death (p = 0.033), knowledge score (p = 0.032), attitude score (p = 0.007), family function (p = 0.003), subjective social support (p = 0.009), and utilization of social support (p = 0.027). Furthermore, an educational level of college or above (p = 0.053), monthly income (p = 0.067), religious belief (p = 0.073), physical health status (p = 0.073), psychological health status (p = 0.099), and objective social support (p = 0.055) showed borderline significance.

Middle-aged and older adults in Shenzhen demonstrated a relatively positive willingness regarding Living Wills. Nine protective factors were identified, including a higher education level, presence of religious belief, higher monthly income, experience of witnessing medical rescue or death, better knowledge of Living Wills, a positive attitude toward Living Wills, good family function and psychological status, and strong social support.

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