Abstract
Across all demographics, preparing for end-of-life care decisions is a pivotal aspect of aging, yet often neglected or approached with reluctance. In a culturally diverse population like the United States, understanding how cultural factors shape such decisions is crucial. A recent study published in the International Journal of Aging & Human Development has cast light on how cultural specifics impact the designation of substitute decision-makers (SDMs) among older Asian Americans. This article delves into the findings of the research, highlighting the role of ethnicity, duration of residence in the United States, English proficiency, and acculturation in influencing end-of-life planning within this demographic.
Introduction
Planning for incapacitation at the twilight years of life is a crucial task that secures dignity and comfort when individuals may no longer voice their wishes. A critical component of this planning is the designation of a substitute decision-maker (SDM), who can make healthcare decisions on behalf of an individual if they become incapacitated. Research has indicated that cultural factors significantly influence the likelihood of designating a SDM, particularly among older Asian Americans, a rapidly growing segment of the aging population in the United States.
The Study
The research paper titled “Factors Associated With Designation of a Substitute Decision-Maker in Older Asian Americans: The Role of Cultural Factors” was co-authored by Min-Kyoung Rhee and Yuri Jang from the USC Edward R. Roybal Institute on Aging and the USC Suzanne Dworak-Peck School of Social Work. The study surveyed 499 Asian Americans aged 60 and over, utilizing data from the 2015 Asian American Quality of Life survey.
Findings
The results indicated that only 22% of the sampled older Asian Americans had completed legal documentation to identify a SDM. Hierarchical logistic regression showed significant impacts of several cultural factors:
Ethnicity: Individuals from different Asian ethnic backgrounds displayed varying propensities for SDM designation, suggesting cultural norms and beliefs critically influence end-of-life planning.
Time in the United States: The duration of residency in the U.S. correlated with the likelihood of appointing a SDM. This may reflect greater exposure to and understanding of healthcare norms in the country.
English Proficiency: English language skills were positively associated with completing SDM designation, which could speak to the role of language barriers in accessing information and services around end-of-life care.
Acculturation: Not surprisingly, higher levels of acculturation led to an increased likelihood of SDM designation, hinting at the integration of U.S. norms and values around healthcare autonomy.
Discussion
This study shines a light on the intersection between culture and healthcare decision-making, underscoring the need for culturally sensitive approaches to end-of-life planning. For older Asian Americans, several cultural barriers can impede the process, from language and information accessibility issues to deeply ingrained beliefs around death and dying.
Cultural Tailoring of End-of-Life Planning
Given the study’s implications, healthcare providers, social workers, and policy makers should consider culturally tailored strategies to encourage and support the end-of-life planning process for older Asian Americans. This could involve translation services, culturally relevant education programs, and outreach efforts specifically designed for different Asian American communities.
Implications and Future Research
The research has paved the way for more in-depth studies to explore cultural nuances further and understand better ways to encourage SDM designation among older adults.
Conclusion
The designation of a SDM is a crucial component of end-of-life care planning, yet underutilized among older Asian Americans. Cultural factors, including ethnicity, time in the U.S., English proficiency, and acculturation levels, significantly influence this process. Addressing these influences through culturally tailored initiatives could improve the uptake of such important healthcare decisions.
References
1. Rhee, M.-K., & Jang, Y. (2020). Factors Associated With Designation of a Substitute Decision-Maker in Older Asian Americans: The Role of Cultural Factors. International Journal of Aging & Human Development, 91(1), 21–36. https://doi.org/10.1177/0091415019848211
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Keywords
1. End-of-Life Planning Asian Americans
2. Cultural Influence Healthcare Decision
3. Substitute Decision-Maker Designation
4. Older Asian American Care Planning
5. Ethnic Diversity EOL Preferences
The article could offer insights and practical strategies for healthcare professionals, older Asian Americans, and their families, guiding them through culturally sensitive end-of-life planning, thereby enhancing the quality of life and care for this growing segment of the population.