Factors Associated With Family Caregivers' Attitudes Toward Withholding Life-Sustaining Treatment in Older Adults With Dementia: A Cross-Sectional Study.

Abstract

Aim: To examine factors associated with family caregivers' attitudes toward withholding life-sustaining treatments (LSTs) for older adults with dementia.

Design: Cross-sectional study.

Methods: A questionnaire survey assessed advance care planning (ACP) knowledge, perceptions of a good death, caregiver burden, and attitudes toward withholding LSTs using previously developed instruments. Hierarchical regression was supplemented by bootstrap confidence intervals, robust inference, and a reduced clinical sensitivity model.

Data sources: Data were collected from 113 family caregivers of older adults with dementia in South Korea from August 28 to September 12, 2022.

Results: Spouse and child caregivers reported more favourable attitudes than other relatives across the main and sensitivity analyses. The association with ACP knowledge was sensitive to model specification and inference method. Associations with religious affiliation, prior family discussion, and perceptions of a good death were not consistently supported in robustness analyses.

Conclusion: The findings suggest areas for further study in caregiver education and early ACP discussions. They do not establish causal effects or demonstrate that changing caregivers' attitudes improves care outcomes.

Implications for nursing practice: Nurses can support accessible ACP education and timely, values-based discussions with older adults and their families, adapting communication to each person's decision-specific capacity and preferences.

Reporting method: The study was reported according to the STROBE guidelines.

No patient or public contribution: The study was designed as a researcher-led questionnaire survey, without patient or public involvement in its design, conduct, analysis, interpretation, or reporting. Family caregivers participated only as survey respondents.