Work

Factors associated with advance directive completion among older adults with and without cognitive impairment: a nationwide cross-sectional study

Year: 2026

Type: article

Abstract: Objective This study aimed to identify and compare the factors associated with advance directive (AD) completion between older adults with and without cognitive impairments, using a nationwide cross-sectional dataset. Methods This study analyzed cross-sectional nationwide data obtained from the 2023 National Survey of Older Koreans, which is conducted every 3 years by the Korean Ministry of Health and Welfare. The study measured cognitive function in a total of 9,951 participants, using the Korean version of the Mini-Mental State Examination for Dementia Screening (K-MMSE-DS). The participants were classified into cognitive impairment ( n = 2,448) and normal cognition ( n = 7,503) groups, and the differences in AD completion based on demographic characteristics, health-related characteristics, and attitudes toward death of the participants in each group were analyzed using the chi-square test. A multivariable logistic regression model was used to identify the factors associated with AD completion. Results Multivariable logistic regression analysis showed that religious affiliation, poorer nutritional status, higher exercise frequency, participation in death preparation education, and higher awareness of dying well were commonly associated with AD completion in both the cognitive impairment and normal cognition groups. Group-specific associations were also identified: in the cognitive impairment group, AD completion was additionally associated with younger age, female sex, higher education, increased prescription medication use, higher independence in activities of daily living, and higher depressive symptom scores, whereas in the normal cognition group, it was additionally associated with a higher number of chronic diseases and history of falls within the past year. Conclusion Different patterns factors associated with AD completion were observed between older adults with and without cognitive impairment, suggesting that strategies to promote AD completion may need to be tailored according to cognitive status.

Source: Frontiers in Public Health

DOI: 10.3389/fpubh.2026.1957140

Authors: Seunghye Choi, Hana Ko

Institution: Gachon University

Language: English

Topic: Palliative Care and End-of-Life Issues

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801