Using Life Course Perspective in Making Health Care Decisions in Later life among older Korean Immigrants

As life expectancy continues to increase in the coming years, the promotion of quality of life in older adults, especially at the end of their lives, grows in importance. Thus, many studies have begun to focus on end of life (EOL) care where health care goals are critical to fulfill an individual’s wishes and goals. Thoughts and values of older adults are diverse and heterogeneous because of their varied life experiences that contribute to their life perspectives (Peace et al., 2011). Beside individual unique life experiences, older adults who immigrated to the US have gone through significant changes in their lives following the changes of culture, which build and shape a person’s beliefs and values. As such, older Korean immigrants in the US hold unique cultural perspectives, including collectivism or filial piety that originated from the influences of Confucius on Korean culture (Kim et al., 2001). These values often dictate how older Korean immigrants perceive their health and lifecycle events, including death. Older adults with multiple chronic conditions (MCC) often experience functional impairment while needing to follow a complex medical treatment plan, thus affecting their capacity for self-care management (Kristensen et al., 2017). While many health care providers frequently encourage early and frequent EOL care discussions with their patients who are at the terminal stage of their illnesses (Lowey et al., 2013), most older adults with MCC feel ill-prepared to discuss their EOL care goals (Etkind et al., 2017). Thus, the purpose of this dissertation study is to explore health care decision making in later life among older Korean immigrants using life course perspective.

In chapter 2, a scoping review was conducted to synthesize the previous studies on Korean Americans and their EOL care. Korean Americans tend to avoid EOL communication hoping that their families would know about their wishes without discussing with them directly. Korean Americans consider advance directives unnecessary, and only a few Korean Americans use advance directives on the purpose of lessening their family’s decisional burden. Many Korean Americans are unaware of what EOL care provides.

In chapter 3, methodological issues in conducting an EOL care study among older Korean immigrants were reported from a descriptive qualitative research that employed a case vignette design. Three semi-structured interviews were conducted and 11 interviews from 4 participants were analyzed using content thematic analysis. Ten themes (research topic, research place, research method, recruitment strategies: age cutoff, document and signature, preferred language, emotional distress, translation, use of case vignettes, and selection bias: positive attitude towards advance directives) were reported and those themes were reported as recruitment phase, data collection phase and data analysis phases.

In chapter 4, a qualitative descriptive study was conducted to explore health care goals and priorities of older Korean immigrants with multiple chronic conditions. Using Life Course Theory as a guiding framework, the study also described how older Korean immigrants with multiple chronic conditions make decisions about health care goals and priorities. Twenty six interviews from 13 participants were analyzed using content thematic analysis. Seven themes (readiness of goal setting, health care goals, health care priorities, time, location, linked lives, turning point) and 14 subthemes were found.

The findings of this dissertation study provides primary data on how older Korean immigrants establish their health care goals and priorities. Future studies to investigate EOL care goals and priorities of general older adult population using life course approach is recommended. Also, I suggest future study on family dynamics between old children and older immigrants and influence on EOL care. The findings of this dissertation also has clinical implication on EOL care communication using narrative method.