Advance directives in Finnish long-term care: Do sociodemographic characteristics and regional factors matter?

Background: Advance directives (AD) help ensure quality end-of-life care by preventing inappropriate or unwanted treatments. This is particularly important for older people in long-term care (LTC). Aims: This study examines sociodemographic and regional factors associated with the presence of ADs among Finnish round-the-clock LTC residents. Methods: This retrospective register study included 6,090 Finnish round-the-clock LTC residents aged ⩾65 years who died of chronic progressive diseases in 2019 and had undergone a comprehensive evaluation of health status and care needs using a standardized, internationally accepted tool (interRAI instrument Minimum Data Set 2.0 for LTC).Regional differences and sociodemographic characteristics associated with the presence of a do-not-resuscitate order (DNR) or other ADs were analyzed using descriptive statistics, chi-squared tests, and multivariable logistic regression. Results: The most common advance directive was a DNR order (84.8%), while other ADs were less frequent (6.7–22.9%). Both DNR orders and other ADs were associated with female sex, Finnish as the native language, having a legal guardian, and dying of neurodegenerative diseases. The prevalence of DNR orders increased with age. ADs were more common in urban than rural municipalities, but there was substantial variation between municipalities (DNR: 70.9–95.0%, other ADs: 27.1–70.0%). Several associations of sociodemographic and regional factors with ADs remained significant after adjusting for functional ability and health stability. Conclusions: Sociodemographic characteristics and regional factors influence whether Finnish long-term care residents have advance directives, regardless of their health status. This may result in unequal care and service use despite similar clinical conditions.