End of Life Care Plan Among Young-Old Adults in South Korea: Willingness to Use Hospice Services and Advance Directives

Purpose: End-of-life care services, such as hospice services (HS) and advance directives (AD), have been identified as crucial resources to improve the quality of care at the end of life. HS provides support and care for individuals with terminal illness, whereas AD advises health care professionals on individuals’ treatment preference when they lose the capacity of decision making. Although death may happen at any time, the vast majority of individuals face their own death in late life.  According to Korean Statistics Information (KSI), about 72.2% of deaths happened in people aged 65 or older in 2012. Given a heavy reliance on family for care for dying older adults in South Korea, use of HS and ADs could be beneficial for both dying individuals and their families. It is, however, unclear how to facilitate such end-of-life care services among older adults in Korea. This study aims to identify factors affecting willingness to use HS and AD. 

Methods: A national interview survey with young-old adults born between 1946 and 1963 was used for this study. 1868 participants who have children and spouses are included in the study. Outcome variables are willingness to use HS (yes/no) and AD (yes/no). Independent variables include knowledge of end-of-life care, perception of death, death of family or relatives in the last year, perceived health, having religion, family relationships, and demographic factors (age, gender, monthly income, and education). Logistic regression analyses were conducted separately to identify factors affecting willingness to use HS and AD using SPSS 21.0.  

Results: The average age of the respondents was 56.12.years (SD=5.15) and 51% of respondents were male (n=952). 79.8% and 74.2% were willing to use HS (n=1491) and AD (n=1388), respectively. Findings from logistic regression analyses showed that age (B=.028, Exp (B) =1.028, p=.045), monthly income (B=.102, Exp (B) =1.108, p<.005), and knowledge of end of life care (B=.165, Exp (B) =1.180, p<.005) were significantly associated with willingness to use HS, whereas education (B=.201, Exp (B) =1.223, p=.020), monthly income (B=.060, Exp (B) =1.062, p=.010), knowledge of end of life care (B=.170, Exp (B) =1.185, p<.005) and death of family or relative in last year (B=.262, Exp (B) =1.200, p=.035) were significantly associated with willingness to use AD. In both models, higher income and better knowledge of end-of-life care are associated with willingness to use both HS and AD. Both logistic regression models were significant (HS: X² = 116.848, p<.005, AD: X² = 125.915, p<.005).

Implications: This study provides a deeper understanding of the needs of end-of-life care services among young-old adults in South Korea. In contrast to prior research, this study showed high preferences for HS and AD, indicating increasing demands for end-of-life care services in South Korea. Furthermore, this study suggests the importance of knowledge of end-of-life care to facilitate end-of-life care services. The more people know about end-of-life care, the better they prepare for their own death. Health care professionals may need to promote open discussion about death and provide educations on end-of-life care plans.