{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T10:09:47Z","timestamp":1783937387711,"version":"3.55.0"},"reference-count":30,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2025,7,13]],"date-time":"2025-07-13T00:00:00Z","timestamp":1752364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,13]],"date-time":"2025-07-13T00:00:00Z","timestamp":1752364800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Scand J Public Health"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Advance directives (AD) help ensure quality end-of-life care by preventing inappropriate or unwanted treatments. This is particularly important for older people in long-term care (LTC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims:<\/jats:title>\n                    <jats:p>This study examines sociodemographic and regional factors associated with the presence of ADs among Finnish round-the-clock LTC residents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This retrospective register study included 6,090 Finnish round-the-clock LTC residents aged \u2a7e65 years who died of chronic progressive diseases in 2019 and had undergone a comprehensive evaluation of health status and care needs using a standardized, internationally accepted tool (interRAI instrument Minimum Data Set 2.0 for LTC).<\/jats:p>\n                    <jats:p>Regional differences and sociodemographic characteristics associated with the presence of a do-not-resuscitate order (DNR) or other ADs were analyzed using descriptive statistics, chi-squared tests, and multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The most common advance directive was a DNR order (84.8%), while other ADs were less frequent (6.7\u201322.9%). Both DNR orders and other ADs were associated with female sex, Finnish as the native language, having a legal guardian, and dying of neurodegenerative diseases. The prevalence of DNR orders increased with age. ADs were more common in urban than rural municipalities, but there was substantial variation between municipalities (DNR: 70.9\u201395.0%, other ADs: 27.1\u201370.0%). Several associations of sociodemographic and regional factors with ADs remained significant after adjusting for functional ability and health stability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Sociodemographic characteristics and regional factors influence whether Finnish long-term care residents have advance directives, regardless of their health status. This may result in unequal care and service use despite similar clinical conditions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/14034948251356016","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T04:44:00Z","timestamp":1752468240000},"page":"589-597","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Advance directives in Finnish long-term care: Do sociodemographic characteristics and regional factors matter?"],"prefix":"10.1177","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6449-5973","authenticated-orcid":false,"given":"Pirita","family":"Forsius","sequence":"first","affiliation":[{"name":"The Department of Healthcare and Social Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland"},{"name":"Faculty of Medicine, University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esa","family":"J\u00e4msen","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Helsinki, Helsinki, Finland"},{"name":"Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harriet","family":"Finne-Soveri","sequence":"additional","affiliation":[{"name":"The Department of Healthcare and Social Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6620-4968","authenticated-orcid":false,"given":"Mari","family":"Aaltonen","sequence":"additional","affiliation":[{"name":"The Department of Healthcare and Social Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland"},{"name":"Faculty of Social Sciences and Gerontology Research Center, Tampere University, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,7,13]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzw060"},{"key":"e_1_3_3_3_2","first-page":"2086","article-title":"Long-term care among old people in the last year of life\u2013 Largest cities compared to the rest of Finland 2002\u20132013 [in Finnish]","volume":"73","author":"Forma L","year":"2018","unstructured":"Forma L, Aaltonen M, Pulkki J, et al. Long-term care among old people in the last year of life\u2013 Largest cities compared to the rest of Finland 2002\u20132013 [in Finnish]. Finnish Med J 2018; 73: 2086\u20132091.","journal-title":"Finnish Med J"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-047086"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12105"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-021-02699-5"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1080\/15524256.2020.1863895"},{"key":"e_1_3_3_8_2","first-page":"438","article-title":"Are hospital\/ED transfers less likely among nursing home residents with do-not-hospitalize orders?","volume":"18","author":"Nakashima T","year":"2017","unstructured":"Nakashima T, Young Y, Hsu WH. Are hospital\/ED transfers less likely among nursing home residents with do-not-hospitalize orders? JAMDA 2017; 18: 438\u2013441.","journal-title":"JAMDA"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2020.09.012"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1100347"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2023.02.003"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269216314526272"},{"key":"e_1_3_3_13_2","article-title":"Advance directives in European long-term care facilities: A cross-sectional survey","volume":"12","author":"Andreasen P","year":"2019","unstructured":"Andreasen P, Finne-Soveri UH, Deliens L, et al. Advance directives in European long-term care facilities: A cross-sectional survey. BMJ Support Palliat Care 2019; 12: e393\u2013402.","journal-title":"BMJ Support Palliat Care"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2018.09.018"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2019.103955"},{"key":"e_1_3_3_16_2","article-title":"Do-not-resuscitate and do-not-hospitalize orders in nursing homes: Who gets them and do they make a difference?","volume":"20","author":"Tanuseputro P","year":"2019","unstructured":"Tanuseputro P, Hsu A, Chalifoux M, et al. Do-not-resuscitate and do-not-hospitalize orders in nursing homes: Who gets them and do they make a difference? JAMDA 2019; 20: 1169\u20131174.e1.","journal-title":"JAMDA"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2016.0473"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1041610217001661"},{"key":"e_1_3_3_19_2","first-page":"1","article-title":"Factors associated with living will among older persons receiving long-term care in Finland","volume":"17","author":"Andreasen P","year":"2023","unstructured":"Andreasen P, Forma L, Pietil\u00e4 I. Factors associated with living will among older persons receiving long-term care in Finland. Palliat Care Soc Pract 2023; 17: 1\u201316.","journal-title":"Palliat Care Soc Pract"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-0361.2004.tb00019.x"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2004.01.010"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-10-166"},{"key":"e_1_3_3_23_2","unstructured":"InterRAI. Status and outcome scales https:\/\/interrai.org\/applications\/status-and-outcome-scales\/ (2025 accessed 5 February 2025)."},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(17)30582-X"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckn020"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13049-019-0663-x"},{"key":"e_1_3_3_27_2","first-page":"269","article-title":"Chronic conditions and multimorbidity in the oldest old \u2013 Associations with functioning and self-rated health. The Vitality 90+ Study [In Finnish]","volume":"31","author":"Halonen P","year":"2017","unstructured":"Halonen P, Enroth L, Jylh\u00e4 M, et al. Chronic conditions and multimorbidity in the oldest old \u2013 Associations with functioning and self-rated health. The Vitality 90+ Study [In Finnish]. Gerontologia 2017; 31: 269\u2013281.","journal-title":"Gerontologia"},{"key":"e_1_3_3_28_2","first-page":"249","article-title":"Association between end-of-life conversations in nursing homes and end-of-life care outcomes: A systematic review and meta-analysis","volume":"20","author":"Gonella S","year":"2019","unstructured":"Gonella S, Basso I, Dimonte V, et al. Association between end-of-life conversations in nursing homes and end-of-life care outcomes: A systematic review and meta-analysis. JAMDA 2019; 20: 249\u2013261.","journal-title":"JAMDA"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40520-021-01972-2"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.18.2387"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049909108322295"}],"container-title":["Scandinavian Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/14034948251356016","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/14034948251356016","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/14034948251356016","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T09:25:25Z","timestamp":1783934725000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/14034948251356016"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,13]]},"references-count":30,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1177\/14034948251356016"],"URL":"https:\/\/doi.org\/10.1177\/14034948251356016","relation":{},"ISSN":["1403-4948","1651-1905"],"issn-type":[{"value":"1403-4948","type":"print"},{"value":"1651-1905","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,13]]}}}