Advance Directives among Elderly Population: A Malaysian Experience
TL Koh1, CS Lei1, TR Tajudin2, Z Abdulshakur3
1 5th-year MBBS student, Asia Metropolitan University, Kuala Lumpur, G-8, Jalan Kemacahaya 11, Taman Kemacahaya, Batu 9, 43200 Cheras, Selangor Darul Ehsan, Malaysia
2 Assistant Professor and Physician, Internal Medicine Department, Asia Metropolitan University, Kuala Lumpur, G-8, Jalan Kemacahaya 11, Taman Kemacahaya, Batu 9, 43200 Cheras, Selangor Darul Ehsan, Malaysia
3 Senior Lecturer and Generalist, Community Health Posting, Asia Metropolitan University, Kuala Lumpur, G-8, Jalan Kemacahaya 11, Taman Kemacahaya, Batu 9, 43200 Cheras, Selangor Darul Ehsan, Malaysia
Source of Support: None, Conflict of Interest: None
Objective: As not many studies have been done on the topic of advance directives in Malaysia and it has yet to gain awareness among our population, we realised the need for a study to be done not only to delineate the prevalence and preference but also to raise the level of awareness.
Methods: In 2015, we carried out a descriptive, cross-sectional study that targeted elderly population residing in six nursing homes and two senior activity centres in Muar. Muar a.k.a "Bandar Di Raja" is a town geographically located in the north-west region of Johor state. Data was collected through a 14 item structured questionnaire which was divided into two sections; socio-demographic profile, prevalence and preference of advance directives.
Results: The response rate for this study was 50% where a total of 70 respondents out of the 150 residents participated. Non-participation was due to the exclusion criteria. 11.4% of the respondents had heard of advance directives, but none so far have an advance directive. Among the respondents, 70% of them are open to the concept of having an advance directive. For the remaining 30% that were against the use of advance directives, 38.1% of them prefer to have decisions done by the doctors. With regards to the recording of advance directives, the verbal promise was the most favored option chosen. As for the preferences for end-of-life treatment, the majority (51%) opted for comfort care with only pain medication.
Conclusion: The prevalence of advance directives in Malaysia is progressing at an extremely slow pace, but it also showed that the elderly population are receptive to the concept of an advance directive. To promote the advancement of advance directives, the level of public awareness needs to be raised through primary care centres and awareness campaigns.