Factors associated with living will among older persons receiving long-term care in Finland
Andreasen, Paula; Forma, Leena; Pietilä, Ilkka (2023)
SAGE Publications
2023
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi-fe20231201150643
https://urn.fi/URN:NBN:fi-fe20231201150643
Tiivistelmä
Background: A living will document is known to be an important tool for preparing for future
care together with healthcare professionals. A living will supports an older person’s selfdetermination
and autonomy. Only a few studies have approached the underlying factors of a
living will document among older long-term care recipients.
Objectives: To explore how common having a living will was among older persons receiving
home care or round-the-clock long-term care, as well as to evaluate associations between
socio-demographical factors and functional capacity with a living will.
Design: The study population consisted of older persons receiving long-term care in Finland
in 2016–2017. Data were collected via individual assessments at home or at a care facility.
The questions in the assessment covered health, functional capacity, service use, and social
support.
Methods: Primary outcome ‘living will’ and associated factors were identified for each person
aged 65 or older from RAI-assessment data (Resident Assessment Instrument, RAI). Crosstabulations
with χ²-tests and adjusted binary logistic regression models were performed to
evaluate the association between the factors and a living will.
Results: Of the 10,178 participants, 21% had a living will – a greater proportion were
female (22%) than male (18%), and a greater proportion of residents in assisted living
(25%) and residential care homes (20%) compared with home care residents (15%) had a
living will. Female gender (p < 0.001), having a proxy decision-maker (p = 0.001), increasing
age (p = 0.003), impairing functional capacity (activities of daily living hierarchy p < 0.001,
Cognitive Performance Scale p < 0.001), instability of health status (Changes in Health, End-
Stage Disease and Signs and Symptoms p < 0.001), and closeness of death (p < 0.001) were
significantly associated with a living will among older persons. Extensive differences in results
were found between home care clients and clients of round-the-clock long-term care.
Conclusion: Preparedness for the future with a living will varies according to services and on
individual level. To reduce inequalities in end-of-life care, actions for advance care planning
with appropriate timing are warranted.
care together with healthcare professionals. A living will supports an older person’s selfdetermination
and autonomy. Only a few studies have approached the underlying factors of a
living will document among older long-term care recipients.
Objectives: To explore how common having a living will was among older persons receiving
home care or round-the-clock long-term care, as well as to evaluate associations between
socio-demographical factors and functional capacity with a living will.
Design: The study population consisted of older persons receiving long-term care in Finland
in 2016–2017. Data were collected via individual assessments at home or at a care facility.
The questions in the assessment covered health, functional capacity, service use, and social
support.
Methods: Primary outcome ‘living will’ and associated factors were identified for each person
aged 65 or older from RAI-assessment data (Resident Assessment Instrument, RAI). Crosstabulations
with χ²-tests and adjusted binary logistic regression models were performed to
evaluate the association between the factors and a living will.
Results: Of the 10,178 participants, 21% had a living will – a greater proportion were
female (22%) than male (18%), and a greater proportion of residents in assisted living
(25%) and residential care homes (20%) compared with home care residents (15%) had a
living will. Female gender (p < 0.001), having a proxy decision-maker (p = 0.001), increasing
age (p = 0.003), impairing functional capacity (activities of daily living hierarchy p < 0.001,
Cognitive Performance Scale p < 0.001), instability of health status (Changes in Health, End-
Stage Disease and Signs and Symptoms p < 0.001), and closeness of death (p < 0.001) were
significantly associated with a living will among older persons. Extensive differences in results
were found between home care clients and clients of round-the-clock long-term care.
Conclusion: Preparedness for the future with a living will varies according to services and on
individual level. To reduce inequalities in end-of-life care, actions for advance care planning
with appropriate timing are warranted.