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

Authors

Seunghye Choi, Hana Ko

Published in

Frontiers in public health. Volume 14. Pages 1957140. Epub Oct 23, 2026.

Abstract

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.
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.
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.
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.

PMID:
42992348
Bibliographic data and abstract were imported from PubMed on 06 Nov 2026.

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