Association between subjective economic status and refusal of life-prolonging treatment: a cross-sectional study using content analysis with stratified random sampling.

Introduction: Older adults tend to refuse life-prolonging treatment for various reasons, and it is important to respect their choice of treatment at the end-of-life stage. The present study examines the associations of subjective economic status and gender with reasons for refusal of life-prolonging treatment in older adults in general population.

Methods: In this cross-sectional study, using stratified random sampling, 1,595 older adults living in Koriyama City, Japan, as of 2016, completed self-administered questionnaires on subjective economic status and preference for life-prolonging treatment, with free-description regarding reasons for refusal. We analyzed the associations between the combination of subjective economic status and gender with frequently mentioned terms and their clusters regarding such reasons, using χ² test, content analysis, text mining and hierarchical cluster analysis.

Results: The combinations of subjective economic status and gender were significantly associated with clustered reasons for refusal of life-prolonging treatment (p < 0.01). The reasons frequently mentioned were: 'avoidance of unnecessary medical care' and 'dignity' in well-off females; and 'financial burden on family' in poor males.

Conclusions: Our findings suggest that older adults who at first glance appear to be freely refusing life-prolonging treatment, may have their decision making restricted through economic constraints.