Advance directives are a controversial, important issue in long term care of African American older adults. This population is much less likely to have advanced directives. African American older adults who remember the Tuskegee experiment and other examples of historical mistreatment in health care are concerned that they will receive inadequate and inferior medical care if they complete advanced directives.
For many older adults, signing an advance directive exacerbates their mistrust and makes them worried that their medical and spiritual needs will be dismissed by health care providers. African Americans approaching end-of-life tend to rely on trusted family members, friends or clergy to speak for them regarding medical decisions. Investigators concluded that family-based oral communication rather than written documents appear to be particularly important to this group (Welch et al, 2005).
Institutional factors may contribute to ethnic differences in use of advance directives. Several investigators suggest that future research should explore:
- The type and amount of staff training practitioners need to provide information about advance directives to African American older adults and their families
- Administrative attitudes about advance directives
- Whether staff deal differently with White and African American individuals in the presentation of advance directive options (Troyer, 2006).