The mediating role of family cohesion in the relationship between death anxiety and readiness toward advance care planning among Chinese community-dwelling older adults: A cross-sectional study

OBJECTIVE: To determine the mediating role of family cohesion in the relationship between death anxiety and readiness toward advance care planning (ACP).

METHODS: This study included 965 Chinese community-dwelling older adults. Pearson correlation coefficient was conducted to assess the relationship between readiness toward ACP, death anxiety, and family cohesion. Structural equation model was used to examine the study hypothetical model.

RESULTS: 965 valid questionnaires were collected. Death anxiety is significantly related to the readiness toward ACP (r = -0.437, P < 0.01) and family cohesion (r = -0.444, P < 0.01), and family cohesion exhibited a positive correlation with readiness toward ACP (r = 0.499, P < 0.01). Family cohesion partially mediated the effect of death anxiety on readiness toward ACP, accounting for 35.94 % of the total effect.

CONCLUSIONS: Family cohesion mediates the relationship between death anxiety and readiness toward ACP. Healthcare professionals should implement measures to alleviate death anxiety and promote family cohesion in older adults, thereby enhancing their readiness toward ACP.