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Background <p>Acceptance of advance care planning (ACP) among older adults is important for the promotion of ACP. It is of great importance to explore the acceptance of ACP and associated influencing factors among older adults in China based on the health ecology model (HEM).</p> Methods <p>Based on a national cross-sectional study in 2022, 4,180 older adults were included. Stepwise linear regression was used to analyze factors associated with acceptance of ACP using SPSS 26.0, based on the HEM. Acceptance scores were calculated based on a self-assessment visual analog scale (range, 0 ~ 100, with higher scores indicating higher acceptance of ACP).</p> Results <p>50.05% (2,092) of 4,180 participants were female. The median acceptance of ACP score was 64, and the range was (49, 81). In addition, the study found higher well-being index (β = 0.086; 95% CI, 0.199 to 0.535; <i>P</i> &lt; 0.001) and health literacy (β = 0.054; 95% CI, 0.07 to 0.423; <i>P</i> = 0.006) scores, broader media use behaviors (β = 0.064; 95% CI, 0.127 to 0.419; <i>P</i> &lt; 0.001), and a higher per capita monthly household income (β = 0.086; 95% CI, 1.827 to 3.825; <i>P</i> &lt; 0.001) were associated with a higher acceptance of ACP, while participants with higher depression scores (β = -0.06; 95% CI, -0.435 to -0.129; <i>P</i> &lt; 0.001), larger social network (β = -0.054; 95% CI, -3.289 to -0.937; <i>P</i> &lt; 0.001), and health insurance (β = -0.04; 95% CI, -7.294 to -1.027; <i>P</i> = 0.008) demonstrated a lower acceptance of ACP.</p> Conclusions <p>For the first time, this study revealed basic personal information, economic status, media use, social networks, health knowledge, and mental health as the main factors associated with acceptance of ACP among older adults in mainland China. These findings were of great significant for enhancing healthcare quality and the overall quality of life for older adults in China.</p>

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Acceptance of advance care planning among older adults in Mainland China: a national cross-sectional study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月6日

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  • Yisong Yao,
  • Xinyue Zhang,
  • Yumei Li,
  • Xiaoqian Xia,
  • Ling Jiang,
  • Xi Chen,
  • Limin Li,
  • Yibo Wu,
  • Xicheng Song

摘要

Background

Acceptance of advance care planning (ACP) among older adults is important for the promotion of ACP. It is of great importance to explore the acceptance of ACP and associated influencing factors among older adults in China based on the health ecology model (HEM).

Methods

Based on a national cross-sectional study in 2022, 4,180 older adults were included. Stepwise linear regression was used to analyze factors associated with acceptance of ACP using SPSS 26.0, based on the HEM. Acceptance scores were calculated based on a self-assessment visual analog scale (range, 0 ~ 100, with higher scores indicating higher acceptance of ACP).

Results

50.05% (2,092) of 4,180 participants were female. The median acceptance of ACP score was 64, and the range was (49, 81). In addition, the study found higher well-being index (β = 0.086; 95% CI, 0.199 to 0.535; P < 0.001) and health literacy (β = 0.054; 95% CI, 0.07 to 0.423; P = 0.006) scores, broader media use behaviors (β = 0.064; 95% CI, 0.127 to 0.419; P < 0.001), and a higher per capita monthly household income (β = 0.086; 95% CI, 1.827 to 3.825; P < 0.001) were associated with a higher acceptance of ACP, while participants with higher depression scores (β = -0.06; 95% CI, -0.435 to -0.129; P < 0.001), larger social network (β = -0.054; 95% CI, -3.289 to -0.937; P < 0.001), and health insurance (β = -0.04; 95% CI, -7.294 to -1.027; P = 0.008) demonstrated a lower acceptance of ACP.

Conclusions

For the first time, this study revealed basic personal information, economic status, media use, social networks, health knowledge, and mental health as the main factors associated with acceptance of ACP among older adults in mainland China. These findings were of great significant for enhancing healthcare quality and the overall quality of life for older adults in China.