Factors affecting elderly Chinese completion of living wills and health care proxies

Abstract

This study sought to understand the problem of the low completion rate of living wills and health care proxies among the elderly Chinese Americans living in metropolitan communities. Grounded in the framework of acculturation theory, it examined two contrasting normative patterns, i.e., individualism and Confucianism, representing elderly Chinese Americans' host culture and home culture respectively.;The research design was a cross-sectional quantitative inquiry with a qualitative component. Convenience sampling was used to select 200 elders from two senior centers in Flushing, NY, where Asian immigrants are concentrated. Structured interviews were conducted using a 97-item questionnaire. A set of unstructured questions was included to obtain more in-depth qualitative information focused on values toward end-of-life issues. The quantitative data was analyzed using descriptive and inferential statistics. Binary logistic regression was applied to statistically control for intervening and alternative variables.;The completion of the documents was related primarily to the elderly Chinese immigrants' values toward end-of-life decisions and to their knowledge about the living will/health care proxy, as well as their access to information and services. In contrast to their cultural norms, respondents were able to discuss what they thought about issues related to death and dying and were willing to adapt to the host country's legal requirements.;The study contributes to social work knowledge by providing a better understanding of the completion of living wills and health care proxies among a group of minority elders, by meeting the need for more empirical studies within the social work profession, by providing information relevant to the gerontological component of the social work education curriculum, and by the enhancement of social work practice in helping clients make end-of-life decisions, especially the minority elderly. The study also provides data supporting efforts to amend the Patient Self-Determination Act (PSDA) to make it more politically viable and ethnically sensitive.;However, the study was geographically limited and the use of convenience sampling may have resulted in the omission of certain subjects. Caution should therefore be exercised in generalizing the findings. Replication studies utilizing more rigorous research designs are recommended.