Attitudes Toward End of Life Issues and Preference of Place of Death in Older People Living in Residential Care Homes in Hong Kong

Background: Older people living in residential care homes for the elderly (RCHEs) have high incidences of irreversible chronic illnesses and terminal diseases. They are the most significant group facing impending death and dying. It is vital to understand their attitudes toward end of life (EOL) issues and their preference for EOL care in order to promote their quality of life.;Objective: This study aims to examine the attitudes toward EOL issues, the preference for place of death, the perception of RCHE as a resident's own home and their predictors amongst older RCHE residents in Hong Kong.;Method: A cross-sectional quantitative study with convenience sampling was conducted in RCHE in different regions of Hong Kong. RCHE residents aged ≥65 achieving abbreviated mental test score ≥6 and who were able to communicate in Cantonese were recruited. Face-to-face interviews were conducted with the aid of a structured questionnaire. Demographic and clinical characteristics were collected. Health and functional status were measured by Euroqol-5D and Barthel Index (20). The 'attitudes of older people to end of life issues questionnaire' was translated from the English version into a Chinese version and employed to examine the attitudes toward EOL issues. The perception of RCHE as own home and the preference for place of death were examined. Univariate analysis on the association between the outcome variables was performed. Factors with a p value <0.25 in univariate analyses were selected for multivariable logistic regression to delineate factors independently associated with the outcome.;Results: A total of 317 participants including 248 (78.2%) women and 69 (21.8%) men from 20 RCHE participated in the study. Their mean age was 84 +/- 6.6 (mean +/- SD). As showed in multivariate analysis, respondents financially supported by their family were less likely to allow doctors to make all the decisions about their care. Those respondents with higher number of morbidities and had higher education were more likely to agree with making a living will. Those who lived longer in RCHE were less likely to agree to having a drug at their disposal to end their life. Respondents with diabetic mellitus were more likely to agree with euthanasia. Respondents who followed a religion were more likely to agree on the importance of spiritual or religious support. Furthermore, 310 (97.8%) respondents perceived RCHE as their own home. Two hundred and sixteen (68.1%) residents wished to die in their present RCHE. Residents with the means to support themselves financially, agreed with euthanasia and who perceived RCHE as their own home were more likely to wish to die in RCHEs.;Conclusion: Nearly all residents perceived RCHEs as their own home and a significant proportion wished to die there if conditions allowed. This asserts that EOL care in RCHE should be developed to meet the wishes of the older residents. This study delineated significant factors associated with the attitudes of older people toward EOL issues. Knowing those factors allows health care professionals to plan for quality EOL care services in RCHEs more effectively and foster good death for this vulnerable population.