# 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.

## Key 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.