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Multidimensional factors influencing the completion of advance directives among community-dwelling older Koreans
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Hee-Ju Ji, Soong-Nang Jang
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J Korean Acad Nurs 2025;55(4):543-556. Published online November 18, 2025
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DOI: https://doi.org/10.4040/jkan.25098
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 Abstract
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- Purpose
This study aimed to examine the multidimensional factors associated with the completion of advance directives (ADs) among community-dwelling older Koreans, guided by conceptual frameworks developed in Asian contexts.
Methods
Data from the 2023 National Survey of Older Koreans (sixth wave) were analyzed for 9,951 community-dwelling older Koreans aged 65 years or older. Complex sample cross-tabulation and binary logistic regression analyses were conducted.
Results
In total, 11.1% of community-dwelling older Koreans had completed an AD. Significant factors associated with AD completion were identified across four domains—personal situation: age, educational level, religion, and housing preference in the event of poor health; socio-cultural: presence of children, participation in social activities and satisfaction with social relationships; physical and illness: the number of chronic diseases; and value system: awareness of hospice and palliative services, participation in death preparedness education, and documentation of organ donation.
Conclusion
Among older Koreans, AD completion represents more than a documentation process; it reflects a complex decision-making process shaped by their values and life circumstances, underscoring the need for supportive interventions. As the highest AD completion rates are found among older adults, related policies should be aligned with older adult-centered policy frameworks.
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