Advance Directive Completion and Its Associated Factors Among Older Chinese Americans.

Journal Article (Journal Article)


To examine the factors of advance directive (AD) completion among older Chinese Americans.


Cross-sectional survey.

Setting and participants

Data came from 435 Chinese Americans aged 55 years and older living in 2 metropolitan areas through self-administered questionnaires and research assistant-administered interviews in 2018. Participants' average age was 75 years (standard deviation = 9.4).


Logistic regression was used to examine factors associated with AD completion.


Approximately 14% of participants completed an AD. Older age [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.02-1.12], higher level of acculturation (OR 2.15, 95% CI 1.39-3.33), higher expectation for intergenerational support (OR 1.52, 95% CI 1.02-2.27), and having US citizenship (OR 3.02, 95% CI 1.26-7.23) were positively associated with AD completion. Physical and mental health needs were not significantly associated with AD completion.

Conclusions and implications

This study is among the first focusing on AD completion among Chinese Americans, one of the fastest-growing older minority populations in the United States. Findings highlight the influence of socioeconomic and cultural factors on AD completion and illustrate the importance of developing culturally sensitive interventions to promote end-of-life care decision making among older Chinese Americans.

Full Text

Duke Authors

Cited Authors

  • Wang, K; Liu, Y; Sun, F; Kong, D; Jiang, L; Wu, B

Published Date

  • February 2021

Published In

Volume / Issue

  • 22 / 2

Start / End Page

  • 344 - 348

PubMed ID

  • 32768374

Electronic International Standard Serial Number (EISSN)

  • 1538-9375

International Standard Serial Number (ISSN)

  • 1525-8610

Digital Object Identifier (DOI)

  • 10.1016/j.jamda.2020.06.049


  • eng