Factors Associated with Living Will Decision-Making among Thai People: A Cross-sectional Study in the Aging Society

Abstract

Thailand is rapidly transitioning into an aging society, increasing the importance of advance care planning, including the establishment of living wills under Section 12 of the National Health Act B.E. 2550 (2007). This study aimed to examine demographic and attitudinal factors associated with attitudes toward making a living will among Thai citizens. Data were derived from the Low Fertility and Aging Society Situation Survey 2024, conducted by the Institute for Population and Social Research, Mahidol University. The sample consisted of 1,042 individuals aged 18 years and older. Data were collected through an online questionnaire and analyzed using descriptive statistics and chi-square tests. The results showed that gender (p = 0.029), age/generation group (p = 0.005), region of residence (p = 0.002) and educational level (p < 0.001) were significantly associated with attitudes toward making a living will, while marital status and occupation were not. In addition, attitudes toward low fertility, pro-natalist policies, and child allowance policy, as well as attitudes toward aging society policies—including redefining older persons as those aged 65 years and over, extending the retirement age to 65 years, and the concept of aging in place—were significantly associated with attitudes toward making a living will (p ≤ 0.001). Among respondents who agreed with making a living will, the highest proportion also supported redefining older persons as those aged 65 years and over (70.2%). These findings suggest that decisions regarding living wills are influenced not only by demographic factors but also by broader social attitudes toward population aging. Therefore, promoting living will completion in Thailand should integrate health literacy development with effective communication of aging policy, particularly targeting working-age and younger populations.