{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T11:48:16Z","timestamp":1782820096536,"version":"3.54.5"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study analyzed determinants of advance-directive (AD) completion for end-of-life preparedness among older Korean adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study used data from 9,796 individuals in the 2023 National Survey of Older Koreans. Complex-sample weighted analyses and multivariate logistic regression were conducted to identify factors associated with AD completion among older Koreans. Sociodemographic, health-status, and death-preparation characteristics were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Multivariate analysis revealed that the strongest predictors of AD completion were organ- or tissue-donation willingness, educational attainment, and writing a will. Other significant factors included funeral consultation and death-preparation education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings suggest that death-preparation behaviors and end-of-life planning activities are significantly associated with AD completion among older Korean adults. Public-health strategies should support targeted education and communication interventions to improve older adults\u2019 engagement in advanced care planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1839072","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T11:19:03Z","timestamp":1782818343000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Determinants of advance-directive completion for end-of-life preparedness among older Korean adults"],"prefix":"10.3389","volume":"14","author":[{"given":"Hyun-Sook","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Health Administration, Kongju National University","place":["Gongju, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang-Mi","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of AI Health Information Management, Yonsei University","place":["Wonju, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"ref1","article-title":"Life Expectancy statistics","year":"2023"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1016\/S0140-6736(16)32381-9","article-title":"Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble","volume":"389","author":"Kontis","year":"2017","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"4","DOI":"10.23062\/2024.10.2","article-title":"The life-sustaining treatment decision scheme in Korea: current status and achievements","volume":"336","author":"Cho","year":"2024","journal-title":"Health Welfare Policy Forum"},{"key":"ref4","article-title":"Yearbook of the Life-Sustaining Treatment Decision-Making System National Agency for Management of Life-Sustaining Treatment","year":"2024"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"45","DOI":"10.23062\/2024.10.5","article-title":"Proposal for end-of-life care policy for dignified end-of-life","volume":"336","author":"Lee","year":"2024","journal-title":"Health Welfare Policy Forum"},{"key":"ref6","volume-title":"Study on the Establishment of the Second Comprehensive Plan for Life-Sustaining Medical Care (2024\u20132028)","author":"Sol","year":"2023"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"256","DOI":"10.7326\/0003-4819-153-4-201008170-00008","article-title":"Redefining the \u201cplanning\u201d in advance care planning: preparing for end-of-life decision making","volume":"153","author":"Sudore","year":"2010","journal-title":"Ann Intern Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1007\/s11019-016-9704-7","article-title":"The near-failure of advance directives: why they should not be abandoned altogether, but their role radically reconsidered","volume":"19","author":"Spranzi","year":"2016","journal-title":"Med Health Care Philos"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1007\/s40520-021-02001-y","article-title":"Advance care planning and advance directives: an overview of the main critical issues","volume":"34","author":"Sedini","year":"2022","journal-title":"Aging Clin Exp Res"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1001\/jamainternmed.2022.1180","article-title":"How traditional advance directives undermine advance care planning: if you have it in writing, you do not have to worry about it","volume":"182","author":"Auriemma","year":"2022","journal-title":"JAMA Intern Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"c1345","DOI":"10.1136\/bmj.c1345","article-title":"The impact of advance care planning on end of life care in elderly patients: randomised controlled trial","volume":"340","author":"Detering","year":"2010","journal-title":"BMJ"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1547","DOI":"10.1111\/j.1532-5415.2009.02396.x","article-title":"Understanding advance care planning as a process of health behavior change","volume":"57","author":"Fried","year":"2009","journal-title":"J Am Geriatr Soc"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/0749-5978(91)90020-T","article-title":"The theory of planned behavior","volume":"50","author":"Ajzen","year":"1991","journal-title":"Organ Behav Hum Decis Process"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e543","DOI":"10.1016\/S1470-2045(17)30582-X","article-title":"Definition and recommendations for advance care planning: an international consensus supported by the European Association for Palliative Care","volume":"18","author":"Rietjens","year":"2017","journal-title":"Lancet Oncol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1016\/j.jpainsymman.2016.12.331","article-title":"Defining advance care planning for adults: a consensus definition from a multidisciplinary Delphi panel","volume":"53","author":"Sudore","year":"2017","journal-title":"J Pain Symptom Manag"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"3771","DOI":"10.3390\/ijerph19073771","article-title":"Factors associated with advance directives documentation: a nationwide cross-sectional survey of older adults in Korea","volume":"19","author":"Kim","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"473","DOI":"10.21086\/ksles.2020.08.27.4.473","article-title":"Completion of advance directive and withdrawal of life-sustaining treatments among older adults in South Korea: a systematic review","volume":"27","author":"Jeon","year":"2020","journal-title":"J Korean Soc Living Environ System"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"123","DOI":"10.22156\/CS4SMB.2016.6.4.123","article-title":"Factors of family function and self-efficasy influencing old patient\u2019s decision of advance directives attitude","volume":"6","author":"Kim","year":"2016","journal-title":"Convergence Soc Small Medium Business"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"240","DOI":"10.5392\/JKCA.2018.18.02.240","article-title":"Completion and related factors of advance directives in older adults","volume":"18","author":"Kim","year":"2018","journal-title":"J Korea Contents Assoc"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.archger.2017.10.008","article-title":"Factors influencing attitudes toward advance directives in Korean older adults","volume":"74","author":"Lee","year":"2018","journal-title":"Arch Gerontol Geriatr"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1177\/1043659615587586","article-title":"Predictors of agreement with writing advance directives among older Korean adults","volume":"27","author":"Park","year":"2016","journal-title":"J Transcult Nurs"},{"key":"ref22","article-title":"The Korean elderly survey, Sejong Ministry of Health and Welfare","year":"2024"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/j.jpsychores.2004.01.004","article-title":"Development of the Korean version of the geriatric depression scale and its short form among elderly psychiatric patients","volume":"57","author":"Bae","year":"2004","journal-title":"J Psychosom Res"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"373","DOI":"10.7475\/kjan.2017.29.4.373","article-title":"The influence of social support among community dwelling elderly and their attitude towards the withdrawal of life-sustaining treatment: a mediating effect of self-esteem","volume":"29","author":"Kim","year":"2017","journal-title":"Korean J Adult Nurs"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"igx012","DOI":"10.1093\/geroni\/igx012","article-title":"Advance care planning: contemporary issues and future directions","volume":"1","author":"Carr","year":"2017","journal-title":"Innov Aging"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"203","DOI":"10.21194\/kjgsw.63.201403.203","article-title":"Research of how the attitude of older people toward their own death affects their self-esteem","volume":"63","author":"Cho","year":"2014","journal-title":"J Welfare Aged"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2733","DOI":"10.22143\/HSS21.12.2.192","article-title":"Intentions of signing advance directives among Koreans aged 65 and older, with policy implications","volume":"12","author":"Lim","year":"2021","journal-title":"J Humanit Soc Sci 21"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"251","DOI":"10.5932\/JKPHN.2020.34.2.251","article-title":"Death anxiety and dignified death attitudes of pre-elderly who opt for signing advance directives","volume":"34","author":"Yang","year":"2020","journal-title":"J Korean Public Health Nurs"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"264","DOI":"10.22705\/jkashcn.2017.24.3.264","article-title":"Factors related to death preparedness among community-dwelling older adults in Korea: using Korean National Survey on elderly 2014","volume":"24","author":"Kim","year":"2017","journal-title":"J Korean Acad Soc Home Health Care Nurs"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"167","DOI":"10.5762\/KAIS.2018.19.8.167","article-title":"Factors contributing to death preparation in community-dwelling elderly: using Korean National Survey on elderly 2014","volume":"19","author":"Lee","year":"2018","journal-title":"J Korea Acad Ind Coop Soc"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"334","DOI":"10.7475\/kjan.2016.28.3.334","article-title":"Factors influencing self determination for withdrawing life-sustaining treatment of the community dwelling elderly","volume":"28","author":"Kim","year":"2016","journal-title":"Korean J Adult Nurs"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"m1927","DOI":"10.1136\/bmj.m1927","article-title":"Reassessing advance care planning in the light of covid-19","volume":"369","author":"Hopkins","year":"2020","journal-title":"BMJ"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"173","DOI":"10.17079\/jkgn.2019.21.3.173","article-title":"Influence of older person\u2019s ego integrity and knowledge of advance directives on their attitude toward withdrawal from life-sustaining treatment","volume":"21","author":"Yeom","year":"2019","journal-title":"J Korean Gerontol Nurs"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1016\/j.jpainsymman.2018.05.016","article-title":"Overview of systematic reviews of advance care planning: summary of evidence and global lessons","volume":"56","author":"Jimenez","year":"2018","journal-title":"J Pain Symptom Manag"},{"key":"ref35","article-title":"Advance directive registration status","year":"2025"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1177\/0091415017709790","article-title":"Correlates of the attitude toward life-sustaining treatment: a study with older adults in South Korea","volume":"86","author":"Jang","year":"2018","journal-title":"Int J Aging Hum Dev"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"25","DOI":"10.35187\/HJAS.2019.7.1.25","article-title":"Effect of death education for the elderly in the senior welfare center in Seoul","volume":"7","author":"Kang","year":"2019","journal-title":"Hallym Univ Institute Aging"},{"key":"ref38","volume-title":"Factors Influencing the Completion of Advance Directives for life-Sustaining Treatment. The 25th International Conference of Public Health Sciences","author":"Lee","year":"2025"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1177\/0269216320979608","article-title":"Advance care planning uptake among patients with severe illness: a systematic review and meta-analysis","volume":"35","author":"Sinclair","year":"2021","journal-title":"Palliat Med"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"489","DOI":"10.14400\/JDC.2016.14.2.489","article-title":"The effects of ego integrity trait of elderly persons on life-sustaining treatment preferences","volume":"14","author":"Lee","year":"2016","journal-title":"J Digit Converg"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1839072\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T11:19:07Z","timestamp":1782818347000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1839072\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,30]]},"references-count":40,"alternative-id":["10.3389\/fpubh.2026.1839072"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1839072","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,30]]},"article-number":"1839072"}}