Advance directive and preference of old age home residents for community model of end-of-life care in Hong Kong

Abstract

Key Messages: 1. Among 1600 cognitively normal elderly persons living in old age homes in Hong Kong, 88% preferred palliative treatments that could keep them comfortable and free from pain, and 88% agreed to have advance directives. Factors that favour having advance directives among Chinese elders included the practice of asking for relatives’ advice in medical decisions, wishing to be informed of their terminal illness diagnoses, absence of a stroke history, and having no problems in self-care. 2. Approximately one third of old age home residents would accept dying in place. Older age, religion (Catholic or non-believer of traditional Chinese religion), having a better mood score (Geriatric Depression Scale), having no siblings, not receiving an old age allowance, and being a resident of subvented old age homes were independent predictors of preference for community end-of-life care and dying in place. 3. End-of-life care in the hospital was expensive. The total bed-day costs for the 2084 deaths in the two clusters for the index death episode, cumulative 3, 6, and 12 months of hospitalisation were HK$65 474 591, HK$82 543 510, HK$100 170 949, and HK$108 960 348, respectively. The annual cost-savings in hospitalisation bed-days would be HK$177 million when about 30% of elders accepted dying in their old age homes. 4. Elderly residents were willing to pay an additional fee for community end-of-life care services in old age homes. Both the services of the doctor and old age home staff were important attributes. Hence, elderly people were prepared to use more community end-of-life care if better staff and doctor services were provided.