1. Reasons for Survey Provide baseline data –What percent of seniors have health care proxies? Provide program guidance –Learn what encourages or discourages people from completing health care proxies (e.g., Are the forms confusing? How worrisome is it to talk to relatives?) Serves as a program announcement and an intervention –Asking questions about health care proxies causes people to think about them, and perhaps act to complete one - just based on this prompting. The current survey (conducted in August ‘05) will also make them more likely to be receptive to the pilots taking place this fall, and the county-wide program to be kicked-off in the spring of ’06.

2. Survey Distribution and Response Rates Survey Conducted through the Health Association of Niagara County, Inc. (HANCI) in August ‘ 05 Foster Grandparent Program- 73 hand distributed to volunteers –84% returns (n = 61) Senior Companion Program - 220 hand distributed to volunteers and clients –18% (N = 39) RSVP- 800 in quarterly newsletter –no return envelope included –5% returns (n = 42) Council on Aging- 300 in newsletter – return addressed envelope included –8% returns (n = 24) Golden Age Program - 300 in newsletter –return addressed envelope included –6% returns (n = 18)

3. Age Distribution of Survey Respondents

4. Age Distribution

5. Factors in Survey Design Validity –Do the questions really measure what they appear to? Reliability –Will the question be answered the same way each time it is asked? Sampling –Are the responses representative of the people you want to measure? Power –Do you have a large enough number of responses so that statistical tests can detect trends and associations

6. A total of 184 responses is large enough that the survey is worthwhile considering, since we have enough statistical power to learn a lot about what those 184 people think about Health Care Proxies (e.g., Does the process seem confusing? Is it easy to find forms? Is it worrisome to talk to loved ones about this?). However, because response rates were so low, caution should be used in generalizing responses to all seniors in Niagara County. For example, it is possible that seniors who have already completed HCP forms were more likely to return surveys because of “social desirability” (i.e., they were proud that they filled out a HCP). Also, it should be noted that the seniors in these “convenience” samples, may not be typical of Niagara County seniors. For example, it is likely that members the Council of Aging, as well as those who participate in the other programs (i.e., RSVP, Golden Age, Senior Companions) are more knowledgeable and active than others their age. Still, the survey provides useful information and baseline data about these “subpopulations.” A two-sided Chi-square test of significance was used to explore the relationship between age category and responses to each survey item. Interpreting Survey Results

7. Have you completed a Health Care Proxy (HCP) Form? No significant differences found between age groups.

8. Have you completed a Health Care Proxy (HCP) Form? No significant differences found between age groups.

9. The steps to complete a HCP and living will are complicated and confusing Younger respondents were more likely to agree. p =.014

10. The steps to complete a HCP and living will are complicated and confusing Younger respondents were more likely to agree. p =.014

11. I don’t know where to get the necessary forms. Younger respondents were more likely to agree. p =.07

12. Talking to loved ones about end of life just makes them worry without doing much good. No significant differences found between age groups.

13. Talking to loved ones about end of life just makes them worry without doing much good. No significant differences found between age groups.

14. Other people who are important to me think I should fill out a health care proxy. Younger people were less likely to agree. P =.003

15. I need to see a lawyer in order to fill out a health care proxy. Younger people were less likely to agree. P =.003

16. Importance of Emotional and Spiritual Needs Younger respondents were less likely to agree that emotional needs are important. p =.003

17. How often do you care for an older adult? Older respondents were more likely to be caregivers p =.02