Readiness for Advance Care Planning among 965 community-dwelling older adults in mainland China:A latent profile analysis

Background Advance Care Planning (ACP) respects individuals' values in end - of - life care. Few studies assess ACP readiness among Chinese community-dwelling older adults using an 'individual - centered' approach to identify subtypes' characteristics. Objective The aim of this study was to: 1) assess the ACP readiness among Chinese community-dwelling older adults; 2) Identify the latent profiles and their influencing factors on community-dwelling older adults' ACP readiness, as well as the differences in death anxiety and family cohesion across each latent profile. Methods A cross-sectional survey was conducted between July and Oct 2023. 965 community-dwelling older adults from four communities in Sichuan, China were recruited. The participants completed the ACP Readiness Scale(ACPRS), Chinese versions of Family Adaptability and Cohesion Evaluation Scale and Death Anxiety Scale. Latent profile analysis identified ACP readiness patterns. Multinomial logistic regression assessed predictors of ACP readiness in different profiles. One-way ANOVA and Student-Newman-Keuls test compared family cohesion and death anxiety for each profile. Results The overall ACPRS score among community - dwelling older adults was 84.86 ± 15.77. Five latent profiles were identified: well-readiness group (n = 551, 57.09%), low-attitude/high-motivation group (n = 199, 20.62%), low-belief group (n = 106, 10.98%), low-motivation/high-attitude group (n = 50, 5.18%) and ill-readiness group (n = 59, 6.11%). Multinomial logistic regression analysis showed age, education, income, number of children, and religion predicted profile membership. There were significant differences in death anxiety and family cohesion among ACP readiness profiles ( P  < 0.001). Conclusion Chinese community-dwelling older adults showed medium ACP readiness. ACP readiness profiles were associated with death anxiety and family cohesion. The profiles' characteristics suggest targeted interventions and coping measures to promote ACP practices.