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Background <p>Advance directives are increasingly recognized as an important means of protecting autonomy in later-life and end-of-life care. However, empirical evidence on attitudes toward advance directives among older adults living in institutional care settings remains limited in China. Social support may be an important relational factor shaping such attitudes. This study aimed to assess attitudes toward advance directives among older adults residing in public eldercare institutions and to examine the association between social support and these attitudes.</p> Methods <p>A cross-sectional survey was conducted between April and June 2023 among 375 older adults from two public eldercare institutions in Guangzhou, China. Data were collected using a general information questionnaire, the Social Support Rating Scale (SSRS), and a questionnaire on attitudes toward advance directives. Descriptive statistics were used to summarize levels of social support and attitudes toward advance directives. Structural equation modeling (SEM) was performed to examine the association between social support and attitudes toward advance directives.</p> Results <p>Participants had a mean SSRS score of 33.86 ± 6.39, with most reporting a medium level of social support. The mean overall attitude score toward advance directives was 3.27 ± 0.81. Among the attitude dimensions, cognitive scores were the lowest (2.71 ± 1.36), whereas behavioral intention scores were the highest (3.74 ± 0.67). SEM showed that social support was positively associated with attitudes toward advance directives (β = 0.348, <i>p</i> = 0.005).</p> Conclusions <p>Older adults in public eldercare institutions showed generally positive attitudes toward advance directives despite relatively limited cognitive understanding. Higher social support was associated with more favorable attitudes toward advance directives, suggesting that attitudes toward future care planning are shaped not only by individual awareness but also by the relational contexts in which older adults live. Interventions to promote advance directives in institutional eldercare should therefore combine information provision with stronger psychosocial and communication support.</p>

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An empirical study on the influence of social support on elderly individuals’ attitudes towards advance directive

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月5日

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  • Yuwen Lyu,
  • Qing Tian,
  • Zhen Qian,
  • Junrong Liu

摘要

Background

Advance directives are increasingly recognized as an important means of protecting autonomy in later-life and end-of-life care. However, empirical evidence on attitudes toward advance directives among older adults living in institutional care settings remains limited in China. Social support may be an important relational factor shaping such attitudes. This study aimed to assess attitudes toward advance directives among older adults residing in public eldercare institutions and to examine the association between social support and these attitudes.

Methods

A cross-sectional survey was conducted between April and June 2023 among 375 older adults from two public eldercare institutions in Guangzhou, China. Data were collected using a general information questionnaire, the Social Support Rating Scale (SSRS), and a questionnaire on attitudes toward advance directives. Descriptive statistics were used to summarize levels of social support and attitudes toward advance directives. Structural equation modeling (SEM) was performed to examine the association between social support and attitudes toward advance directives.

Results

Participants had a mean SSRS score of 33.86 ± 6.39, with most reporting a medium level of social support. The mean overall attitude score toward advance directives was 3.27 ± 0.81. Among the attitude dimensions, cognitive scores were the lowest (2.71 ± 1.36), whereas behavioral intention scores were the highest (3.74 ± 0.67). SEM showed that social support was positively associated with attitudes toward advance directives (β = 0.348, p = 0.005).

Conclusions

Older adults in public eldercare institutions showed generally positive attitudes toward advance directives despite relatively limited cognitive understanding. Higher social support was associated with more favorable attitudes toward advance directives, suggesting that attitudes toward future care planning are shaped not only by individual awareness but also by the relational contexts in which older adults live. Interventions to promote advance directives in institutional eldercare should therefore combine information provision with stronger psychosocial and communication support.