Frailty status influences the attitudes towards end-of-life care among Chinese centenarians in Hong Kong

Abstract

Introduction: As the society rapidly ages, planning for health care towards the end-of-life is important for older people and their families. This study examined the attitudes towards end-of-life care amongst near-centenarians and centenarians, and the influence of frailty status on these attitudes. Method: Data for 131 participants (76% female, mean age 97.5, range 95-108 years) were extracted from the Hong Kong Centenarian Study. 80% of the participants were community-dwelling (49% with family, 31% alone), whilst the remaining 20% were institutionalized. Participants were asked to indicate their agreement on three items: (a) the society’s acceptance on advance directives; (b) the society’s acceptance on euthanasia; and (c) the idea that under no circumstance should anybody seek to hasten death. We assessed frailty status using a multidimensional model including items on physical health, psychological well-being, socio-familial conditions, environmental barriers to social activities, and economic conditions. Multiple regressions were performed to examine the relationship between frailty status and attitudes towards end-of-life care. Results: 69% and 60% of the 131 participants believed that the society did not accept advance directives and euthanasia, respectively; and 89% believed that under no circumstance should one hasten death. Centenarians with higher levels of frailty were more likely to believe in acceptance of advance directives (beta=.23), euthanasia (beta=.26) and under no circumstance should anybody seek to hasten death (beta=.21), after controlling for the effects of gender, age, and living arrangement. Conclusion: Acceptance of advance directives and euthanasia is low amongst community-dwelling extremely old adults in Hong Kong, and the vast majority do not believe in hastening death under any circumstances. However, these attitudes are significantly influenced by their frailty status. Further studies are needed to compare with the attitudes amongst younger-old adults. Greater efforts in raising public awareness about the end-of-life care options are warranted to facilitate choices and autonomy in the final phase of their lives.