The Barriers of Implementing Advance Directives at the End of Life Care of Older Adults

Introduction: Recently, Advance Directive (AD) has been noticed in some developed countries, especially among the elderly. It is a legal document based on the principle of autonomy that lists a person's care preferences for when they are unable to make decisions. AD seeks to legitimize people's preferences, especially when they receive end-of-life care. AD leads to improving the quality of care provided to older adults but the completion rate of AD is low, so it seems necessary to review the barriers of completion of this legal document.Materials and Methods: In this review article an electronic search with keywords “Advance Directives”, “Aged” and “Terminal Care” were done without time limitation in scientific databases such as Web of Science, Google Scholar, PubMed, Scopus, ProQuest, Magiran and SID in Tehran-۲۰۲۲. The criteria for entering the research are relevance, full text, quantitative and qualitative structure, and publication in Farsi and English. After checking by two researchers, the articles were excluded from the study if the content was repetitive or not related to the topic. Data reliability and validity were confirmed through the Lincoln and Guba method.Results: The results of ۱۵ studies show that the barriers to completing the AD can be placed in the following three categories: individual barriers (younger age, male gender, lower income, racial minorities, lower education, and being single), psycho-social barriers (lack of understanding the severity of the disease and lack of social support) and spiritual barriers (lack of spirituality, death anxiety, and fear of death). Furthermore, factors related to health status, such as having cognitive problems, and recent hospitalization can also affect the desire to complete AD.Conclusion: Considering the physical, social, economical, and cultural factors of the elderly regarding implementing the AD can reduce the obstacles to the implementation of advanced directives. Also, adopting national policies and carrying out interventions such as public education based on family participation, regardless of the age or health status of the older adults, makes these people decide based on their preferences. In addition, evidence suggests that AD can significantly reduce the costs of medical and end-of-life care.

Keywords:

Advance Directives , Aged , Terminal Care.