Readiness for Decision Making towards End-of-Life Care among Unmarried or Divorced Middle-aged and Elderly Men in Japan

Abstract

BACKGROUND: Previous research has found that 70% of patients are unable to express their end-of-life (EOL) preferences. Hospitals in Japan often ask the patient’s family members to guess and express the patient’s will and take decisions on his/her behalf, but never-married and divorced men often have no relatives to fulfill such functions. METHODS: An internet survey was conducted on February 14–24, 2020. The sample size was 3,224 and it was balanced among 3 layers: gender, age (50s, 60s, 70s+), and marital status (never-married, divorced, widowed, married). The sample included 471 never-married men and 472 divorced men. RESULTS: Overall, it was found that 3.1% had no support in the event of hospitalization. Among all participants, the never-married or divorced men had little contact with relatives, few friends, and little communication with their neighbors; 20% of them had no one to support them when hospitalized. Sixty percent of all participants never discussed their advanced care planning (ACP) with their families or friends, and this number was around 84% among never-married or divorced men. Among all participants, 11.7% had written an “ending note” to communicate their will regarding end-of-life and after-death decisions. This number was much lower for never-married men at 3.6%. CONCLUSIONS: As never-married and divorced men have little chance to share their thoughts with others, they are more likely to have difficulties in making and communicating EOL decisions. The number of never-married elderly men is increasing rapidly, and a solution to help them express their EOL decisions is needed.