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- Title
End-of-Life Preference Discussions between Elderly Japanese American Men and Their Families: The Honolulu-Asia Aging Study.
- Authors
Shinji Ito; Okamoto, Lauren; Bell, Christina; Fong, Kaon; Masaki, Kamal
- Abstract
Background: Challenging cases in geriatrics often involve lack of communication regarding end-of-life preferences and cultural issues. There have been no previous population-based studies on acculturation and end-of-life preference discussions among older Japanese-Americans. Methods: The Honolulu-Asia Aging Study is a continuation of the Honolulu Heart Program, a longitudinal cohort study in Japanese-American men in Hawai'i that began in 1965. In the 2009-10 exam, participants identified a proxy informant who answered questions about their knowledge of the men's end-of-life preferences. We studied the relationship between end-of-life preference discussions and completion of a written advance directive and actual preferences for end-of-life care, as well as associations between discussions and demographic and cultural factors. The Cultural Assimilation Scale (CAS) consisted of 8 questions assessing degree of Japanese identity and lifestyle. Results: Among 350 participants aged 89-108 years, proxy informants were wives (29.4%), daughters (29.4%), sons (22.0%), other relatives (8.0%) and others (mostly paid caregivers, 11.1%). On proxy interview, 70.7% reported end-of-life preference discussions and 29.3% did not. Those who had end-of-life preference discussions were more likely to have completed a written advance directive compared to those without discussions (93.6% vs 61.5%, P < .0001). Even among those with discussions, many proxies were unsure about certain preferences, including tube feeding (27.4%), nursing home care (23.8%) and dementia care (20.2%). Factors associated with having end-of-life preference discussions included Christian religion (vs Buddhist/Shinto, OR = 1.85, 95% CI = 1.00-3.41, P < .05) and daughter as proxy informant (vs wife, OR = 2.34, 95% CI = 1.20-4.54, P = .01), but no associations with age, education, marital status or acculturation scores. Conclusion: Among this oldest-old population, there were almost 30% who did not have end-of-life preference discussions. Among those who did have these discussions, almost a quarter did not know about preferences regarding tube feeding, nursing home care or dementia care. Religion was the only acculturation factor associated with end-of-life preference discussions. Participants with daughters as proxy informants had higher odds of end-of-life preference discussions.
- Subjects
TERMINAL care; OLDER people; JAPANESE American men
- Publication
Hawaii Journal of Medicine & Public Health, 2015, Vol 74, p49
- ISSN
2165-8218
- Publication type
Abstract