scholarly journals The Mediation Role of Socioeconomic Status on Racial and Ethnic Differences in Advance Care Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 333-333
Author(s):  
Junghee Han ◽  
Taekbeen Nam
Keyword(s):  
Ethnic Differences ◽  
Advance Care Planning ◽  
Mediating Effect ◽  
Living Wills ◽  
Care Planning ◽  
Advanced Directives ◽  
Advance Care ◽  
Eol Care ◽  
Racial Ethnic

Abstract Background. Most research on EOL care planning has focused on racial/ethnic differences in completing advanced directives (AD) rather than the pathways of the disparities. Therefore, this study aims to examine the mediating role of education and income in racial/ethnic differences in EOL care planning. Methods. A secondary data analysis of Health and Retirements Study (HRS) 2004-2014 wave was used. The sample included 6,518 participants ((≥ 65 years old). The independent variable measured the respondents’ race and ethnicity and the dependent variable measured the completion rate of living wills or the Durable Power of Attorney of Health Care (DPAHC). Covariates included gender, age, marital status, religion, place f birth, educational attainment, income, cognitive function, limitations in physical functioning, geriatric syndromes, and the number of progressive chronic disease. Results. The hierarchical logistic regression analysis showed that race/ethnicity was a significant predictor of completing AD (p≤0.001). Mediation analysis, Karlson, Home, and Breen (KHB), revealed that both education and income explained 14.4% of racial/ethnic differences in completion of living wills for non-Hispanic Blacks and 17.6% for Hispanics. Similarly, education and income accounted for 17.6% of racial/ethnic disparities in completion of DPAHC for non-Hispanic Blacks and 20.9% for Hispanics. In particular, education had stronger mediating effect on the outcome variables than income. Discussion. The findings suggest the importance of targeted educational interventions for people of color with lower SES to raise their awareness of benefits of advance care planning and increase their access to higher quality of EOL care.

scholarly journals The Association Between Hearing Loss and Completion of Advance Care Planning Among Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 332-332
Author(s):  
Junghee Han ◽  
Junghyun Park
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Chronic Disease ◽  
Advance Care Planning ◽  
Living Wills ◽  
Health Concern ◽  
Care Planning ◽  
Advance Care ◽  
Eol Care ◽  
The Impact

Abstract Background: Ensuring access to quality end-of-life (EOL) care for all older adults is emerging public health concern. Hearing loss (HL) is the third most common chronic disease affecting older adults and a major impediment to access healthcare services. However, little is known about the impact of HL on advance care planning for older adults. Method: A sample of 1,862 older adults (≥65 years) was drawn from the National Health and Aging Trends Study (NHATS). HL was determined by self-report and advance care planning was measured by asking if an individual completed living wills or the Durable Power of Attorney for Health Care (DPAHC). Covariates included age, gender, race, marital status, education, religion, nativity, depression, region, facility status, regular doctor availability, Medicaid, hospitalization, cognition, perceived health status and a presence of chronic disease. Results: Descriptive statistics revealed that nearly 67% of older adults with HL completed the DPAHC, and the majority of them (71%) also had living wills. Multivariable logistic regression analyses showed that HL was significantly associated with completion of DPAHC and living wills, after controlling for a list of covariates (OR=0.50, p<0.05). Conclusions: The findings show HL is a significant predictor of completion of any type of advance directives. Facilitating effective communication in advance care planning for older adults with HL is needed. Healthcare provider should make health information accessible to them to get quality EOL care.

scholarly journals Assisted Living Administrators’ Approaches to Advance Care Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 66-66
Author(s):  
Elise Abken ◽  
Alexis Bender ◽  
Ann Vandenberg ◽  
Candace Kemp ◽  
Molly Perkins
Keyword(s):  
Advance Care Planning ◽  
Assisted Living ◽  
Staff Training ◽  
Chronically Ill ◽  
External Support ◽  
Care Plan ◽  
Care Planning ◽  
Term Care ◽  
Advance Care ◽  
Eol Care

Abstract Assisted living (AL) communities are increasingly home to frail, chronically ill older adults who remain until death. State laws mandate that AL facilities request copies of any advance care planning documents residents have and make forms available upon request. Using secondary data from a larger study funded by the National Institute on Aging (R01AG047408) that focuses on end-of-life (EOL) care in AL, this project investigated barriers and facilitators to conducting advance care planning in AL. Data included in-depth interviews (of 86 minute average length) with 20 administrators from 7 facilities around the Atlanta metropolitan area and aggregate data collected from each facility regarding facility, staff, and resident characteristics. Findings from thematic analysis of qualitative data showed that key barriers to planning in AL included lack of staff training and reluctance among administrators and families to discuss advance care planning and EOL care. Important facilitators included periodic follow-up discussions of residents’ wishes, often during care plan meetings, educating families about the importance of planning, and external support for staff training and family education from agencies such as hospice and home health. Three study facilities exceeded state requirements to request and store documents by systematically encouraging residents to complete documentation. These facilities, whose administrators discuss advance care planning and residents’ EOL wishes with residents and families during regular care plan meetings, were more likely to have planning documents on file, demonstrating the potential of long-term care communities, such as AL, to successfully promote advance care planning among residents and their family members.

Association of advance care planning with place of death and utilisation of life-sustaining treatments in deceased patients at Taipei City Hospital in Taiwan

2020 ◽  
pp. bmjspcare-2020-002520
Author(s):  
Yung-Feng Yen ◽  
Ya-Ling Lee ◽  
Hsiao-Yun Hu ◽  
Wen-Jung Sun ◽  
Ming-Chung Ko ◽  
...  
Keyword(s):  
Cohort Study ◽  
Advance Care Planning ◽  
Place Of Death ◽  
Care Planning ◽  
City Hospital ◽  
Taipei City ◽  
Advance Care ◽  
Eol Care ◽  
To Receive ◽  
At Home

ObjectiveEvidence is mixed regarding the impact of advance care planning (ACP) on place of death. This cohort study investigated the effect of ACP programmes on place of death and utilisation of life-sustaining treatments for patients during end-of-life (EOL) care.MethodsThis prospective cohort study identified deceased patients between 2015 and 2016 at Taipei City Hospital. ACP was determined by patients’ medical records and defined as a process to discuss patients’ preferences with respect to EOL treatments and place of death. Place of death included hospital or home death. Stepwise logistic regression determined the association of ACP with place of death and utilisation of life-sustaining treatments during EOL care.ResultsOf the 3196 deceased patients, the overall mean age was 78.6 years, and 46.5% of the subjects had an ACP communication with healthcare providers before death. During the study follow-up period, 166 individuals died at home, including 98 (6.59%) patients with ACP and 68 (3.98%) patients without ACP. After adjusting for sociodemographic factors and comorbidities, patients with ACP were more likely to die at home during EOL care (adjusted OR (AOR)=1.71, 95% CI 1.24 to 2.35). Moreover, patients with ACP were less likely to receive cardiopulmonary resuscitation (AOR 0.36, 95% CI 0.25 to 0.51) as well as intubation and mechanical ventilation support (AOR 0.54, 95% CI 0.44 to 0.67) during the last 3 months of life.ConclusionPatients with ACP were more likely to die at home and less likely to receive life-sustaining treatments during EOL care.

scholarly journals Does the Experience of Caring for a Severely Disabled Relative Impact Advance Care Planning? A Qualitative Study of Caregivers of Disabled Patients

2020 ◽  
Vol 17 (5) ◽  
pp. 1594
Author(s):  
Fu-Ming Chiang ◽  
Jyh-Gang Hsieh ◽  
Sheng-Yu Fan ◽  
Ying-Wei Wang ◽  
Shu-Chen Wang
Keyword(s):  
Decision Making ◽  
Medical Care ◽  
Advance Care Planning ◽  
Qualitative Content Analysis ◽  
Care Planning ◽  
Medical Decisions ◽  
Self Blame ◽  
Advance Care ◽  
Past Experiences ◽  
Eol Care

The aging of the Taiwanese population has become a major issue. Previous research has focused on the burden and stress faced by caregivers, but has not explored how the experience of these caregivers influences decisions of advance care planning (ACP). Semi-structured and in-depth interviews were conducted. Qualitative content analysis was used to identify important themes. Five themes and fourteen sub-themes were identified: (1) Past experiences: patient wishes, professional recommendations, and expectation about disease progress; (2) Impact of care on family members: positive affirmation, open-minded life, social isolation and health effects, and financial and life planning effects; (3) Attitude toward life: not forcing to stay, and not becoming a burden, (4) Expected proxy dilemmas: torment between doing or not, seeing the extension of suffering and toil, and remorse and self-blame; (5) Expectation of end of life (EOL) care: caregiver’s experience and EOL care decisions, and practicality of EOL decision making. After making multiple medical decisions for their disabled relatives, caregivers are able to calmly face their own medical decisions, and “not becoming a burden” is their primary consideration. It’s suggested that implementation of shared decision-making on medical care for patients with chronic disability will not only improve the quality of their medical care but also reduce the development of remorse and guilty feelings of caregivers after making medical decisions.

scholarly journals THE ROLE OF PERSONALITY IN ADVANCE CARE PLANNING

2017 ◽  
Vol 1 (suppl_1) ◽  
pp. 113-113
Author(s):  
K. Kittle ◽  
B. Gaines ◽  
K. Boerner
Keyword(s):  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care

scholarly journals Advance Care Planning for People with Dementia: The Role of General Practitioners

Gerontology ◽  
2019 ◽  
Vol 66 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Klaus W. Bally ◽  
Tanja Krones ◽  
Ralf J. Jox
Keyword(s):  
General Practitioners ◽  
Advance Care Planning ◽  
Care Planning ◽  
People With Dementia ◽  
Advance Care
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