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The Relationship Between Ethnicity and Advance Directives in a Frail Older Population
Author(s) -
Eleazer G. Paul,
Hornung Carlton A.,
Egbert Carolyn B.,
Egbert John R.,
Eng Catherine,
Hedgepeth Jennifer,
McCann Robert,
Strothers Harry,
Sapir Marc,
Wei Ming,
Wilson Malissa
Publication year - 1996
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1996.tb01864.x
Subject(s) - medicine , ethnic group , gerontology , health care , pace , psychological intervention , proxy (statistics) , population , family medicine , nursing , environmental health , geodesy , machine learning , sociology , anthropology , computer science , geography , economics , economic growth
OBJECTIVE: To assess the relationship between ethnicity and Health Care wishes, including Advance Directives, in a group of frail older persons in PACE (Program For All Inclusive Care Of The Elderly). DESIGN: Retrospective chart review of 1193 participants in the PACE program. SETTING: Program of All Inclusive Care Of The Elderly (PACE), a comprehensive managed care demonstration program serving frail older participants at 10 sites across the nation. PARTICIPANTS: A total of 1193 older adults, all of whom met state criteria for nursing home level of care. There were 385 non‐Hispanic whites, 364 blacks, 156 Hispanics, and 288 Asians. MEASUREMENTS: Presence or absence of advance directives, type of health care wishes selected including living will, durable power of attorney, and health care proxy. RESULTS: Frail older white, black, Hispanic and Asian Americans differ significantly in their health care wishes and how they choose to express them. Blacks were significantly more likely to select aggressive interventions and less likely than non‐Hispanic whites and Hispanics to utilize a written instrument for expressing health care wishes. Whites were significantly more likely to utilize written documents for advance directives, whereas Asians were more likely to select less aggressive interventions but were unlikely to use written advance directives. CONCLUSIONS: In this population, we found significant ethnic variations in choice of health care wishes. Although health care wishes are an individual decision, an awareness of cross cultural patterns can assist practitioners in addressing the concerns of their patients, as well as assisting Health Care Policy Development. J Am Geriatr Soc 44:938–943, 1996.