scholarly journals The Role of Health, Social Network, and Race in Advance Care Planning Among Medicare Beneficiaries

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 69-70
Author(s):  
Jung Kwak ◽  
Heehyul Moon ◽  
Soonhee Roh
Keyword(s):  
Older Adults ◽  
Social Network ◽  
African Americans ◽  
Advance Care Planning ◽  
Living Will ◽  
Individual Characteristics ◽  
Care Planning ◽  
Medicare Beneficiaries ◽  
Advance Care

Abstract Advance care planning (ACP) is linked with high-quality end-of-life outcomes. However, ACP engagement level among older adults varies significantly by demographic, social, and health characteristics. In this study, we sought to identify characteristics associated with informal and formal ACP, in order to inform development of targeted education and outreach efforts that are tailored to diverse groups of older adults. The data came from a nationally representative study of Medicare beneficiaries living in communities, the National Health and Aging Trends Study (Round 8, N= 5,547). Multivariable logistic regressions were conducted to identify individual characteristics (i.e., race/ethnicity, age, gender, income, functional disability, cognitive function, perceived health, and numbers of people in social networks) associated with ACP engagement. Rates of informal ACP (talking to someone), and formal ACP, completing a healthcare power of attorney (HPOA) and a living will (LW), were 56%, 60.5%, and 56% accordingly. Logistic regression showed that individuals who were married or had a larger social network, and had higher functional impairment and health needs were significantly more likely to engage in both informal and formal ACP. However, individuals with memory problems (only informal ACP) and African Americans and Hispanics were significantly less likely to engage in both informal and formal ACP. African Americans without dementia were more likely to have completed HPOA compared with Whites. Findings suggest an important role of social network, and functional and cognitive health in ACP with implications for developing targeted outreach efforts in faith-based or social group settings, and healthcare settings.

Advance care planning among older LGBT Canadians: Heteronormative influences

Sexualities ◽  
2020 ◽  
pp. 136346071989696
Author(s):  
Brian de Vries ◽  
Gloria Gutman ◽  
Shimae Soheilipour ◽  
Jacqueline Gahagan ◽  
Áine Humble ◽  
...  
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Advance Care Planning ◽  
Cultural Context ◽  
Death And Dying ◽  
Living Will ◽  
Community Dwelling ◽  
Care Planning ◽  
Power Of Attorney ◽  
Advance Care

Advance care planning (ACP) in North America often takes place in a cultural context of great ambivalence about death and dying, challenging efforts to discuss end-of-life care desires and preparations for death. Such challenges are amplified for sexual and gender minority older adults who often lack connections to traditional heteronormative systems of support. The extent of ACP preparation (completed documents, discussions) and their predictors was examined among a national sample of 91 community-dwelling Canadian LGBT older adults (mean age 68). The sample was disproportionately single and lived alone; more trans participants had children and about half of all participants reported a chosen family. About two-thirds of participants had a will, while less than half had a living will and power of attorney for health care, and a quarter had made informal caregiving arrangements. Just over one-third of respondents reported having discussions about future care and end-of-life plans. The only significant predictors of both ACP documents completed and ACP discussions undertaken were relationship status (those in a relationship were more likely to have engaged in both) and number of children (those with children were less likely to have completed documents). Given that most LGBT older adults are single, efforts must be expanded to reach and engage these individuals in preparing for end of life.

Religiosity and Death Attitudes and Engagement of Advance Care Planning Among Chronically Ill Older Adults

2011 ◽  
Vol 34 (2) ◽  
pp. 113-130 ◽  
Author(s):  
Debra Dobbs ◽  
Catherine Parsons Emmett ◽  
Ashley Hammarth ◽  
Timothy P. Daaleman
Keyword(s):  
Older Adults ◽  
North Carolina ◽  
Advance Care Planning ◽  
Chronically Ill ◽  
Living Will ◽  
Fear Of Death ◽  
Care Planning ◽  
Death Attitudes ◽  
Primary Care Clinics ◽  
Advance Care

The aim of this study was to examine the association of religiosity and death attitudes with self-reported advance care planning (ACP) in chronically ill older adults. Survey data were collected in person for a sample of 157 chronically ill older adults drawn from primary care clinics in North Carolina. Logistic regression was used to examine associations of religiosity and death attitudes in the likelihood of engagement in three ACP outcomes: (a) ACP discussions with the doctor, (b) ACP discussions with family, and (c) the completion of a living will. Greater reported religiosity ( b = 1.67, p < .01) was significantly associated with reported ACP discussions with the doctor ( R2 = .29, model significance p < .01). Less fear of death was significantly associated ( b = −0.41, p < .01) with self-reported completion of a living will ( R2 = .21, model significance p < .01). Religiosity and fears of death should be considered in future ACP studies.

scholarly journals REGIONAL VARIATIONS IN ENGAGEMENT IN ADVANCE CARE PLANNING AMONG RACIALLY AND ETHNICALLY DIVERSE OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S274-S275
Author(s):  
Kyeongmo Kim ◽  
Michin Hong ◽  
Giyeon Kim
Keyword(s):  
Older Adults ◽  
Logistic Regression ◽  
African Americans ◽  
South African ◽  
Advance Care Planning ◽  
Care Planning ◽  
The West ◽  
Advance Care ◽  
Racial Ethnic ◽  
The U.S

Abstract Advance care planning (ACP) has positive effects on the quality of end-of-life of older adults. Given the influence of environmental factors on health and behavioral health behaviors among older adults, geographic variations may exist in engagement in ACP. This study examined whether 1) there was a regional variation in engagement in ACP and 2) there was a racial/ethnic difference in ACP across regions (Northeast, Midwest, South, and West). Drawn from the 2012 National Health and Aging Trends Study, 2,015 Medicare beneficiaries in the U.S. were included in analyses. Results from logistic regression analysis showed that older adults living in the West (OR=1.66, p=0.003) and the Midwest (OR=1.39, p=0.032) were more likely to be engaged in ACP compared to those living in the South. African Americans (OR=0.31, p&lt;0.001), Hispanics (OR=0.30, p&lt;0.001), and other races (OR=0.49, p=0.04) were less likely than their white counterparts to be engaged in ACP. We also conducted four separate logistic regression analyses by regions. In the Northeast, Midwest, and South, African Americans were less likely to be engaged in ACP compared to whites. In the West, Hispanics were less likely to be engaged in ACP compared to whites. Findings from this study provide a clear picture of racial/ethnic disparities in ACP across different regions in the U.S., suggesting where to target for future interventions to improve engagement in ACP among racial/ethnic minorities. Future research should be conducted at lower levels of geographic areas to find modifiable geographic factors to improve engagement in ACP among older adults.

Insufficient Advance Care Planning? Correlates of Planning Without Personal Conversations

2020 ◽  
Vol 76 (1) ◽  
pp. 104-108
Author(s):  
Kathrin Boerner ◽  
Sara M Moorman ◽  
Deborah Carr ◽  
Katherine A Ornstein
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Health Care Professionals ◽  
Multinomial Logistic Regression ◽  
Living Will ◽  
Care Planning ◽  
Care Providers ◽  
Advance Care

Abstract Objectives Advance care planning (ACP) typically comprises formal preparations (i.e., living will and/or durable power of attorney for health care) and informal discussions with family members and health care providers. However, some people complete formal documents without discussing them with others. If they become incapacitated, their appointed decision makers may lack guidance on how to interpret or enact their formal wishes. We document the prevalence and correlates of this partial approach to ACP. Method Using multinomial logistic regression models and data from a U.S. sample of 4,836 older adults in the 2018 wave of the National Health and Aging Trends Study (NHATS), this brief report evaluated associations between social integration indicators and the odds of completing (a) both discussions and formal plans (two-pronged ACP), (b) discussions only, (c) no ACP, and (d) formal ACP only (reference category). We adjust for demographic and health characteristics established as correlates of ACP. Results A minority (15%) of NHATS participants reported formal plans without having discussed them. Indicators of social isolation (e.g., smaller social networks and fewer social activities) increased the odds of engaging in formal planning only compared to two-pronged ACP. Socioeconomic disadvantage and probable dementia reduced the odds of having end-of-life conversations, whether as one’s only preparation or in tandem with formal preparations. Discussion Socially isolated persons are especially likely to do formal planning only, which is considered less effective than two-pronged ACP. Health care professionals should recognize that older adults with few kin may require additional support and guidance when doing ACP.

scholarly journals Association Between Caregivers’ and Care-Recipients’ Advance Care Planning: An Exploratory Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 416-417
Author(s):  
Hyunjin Noh ◽  
Lewis Lee ◽  
Chorong Won
Keyword(s):  
Older Adults ◽  
Advance Care Planning ◽  
Qualitative Content Analysis ◽  
Living Will ◽  
Care Recipient ◽  
Care Planning ◽  
Chi Square ◽  
Initial Exposure ◽  
Care Recipients ◽  
Advance Care

Abstract Research on advance care planning (ACP) has highlighted major contributors to the completion of ACP documents. One of such contributors is knowledge about ACP, such as an advance directive or living will (LW). This study aims to 1) understand the initial exposure to ACP knowledge among informal caregivers’ of chronically or seriously ill older adults and to 2) explore an association between caregivers’ advance care planning and that of their care-recipients. Forty-four primary caregivers of cognitively impaired older adults were recruited at various community settings. A mixed-method design was used to qualitatively interview each participant face-to-face about his or her initial experience with ACP and to quantitatively ask if the participant completed a LW and if the care-recipient completed one as well. Qualitative content analysis of participant responses revealed that their initial experiences with ACP were mostly through their care-recipients, such as the care-recipient’s ACP in previous hospitalizations or legal consultations. Chi-square test for independence was conducted to explore whether there is an association between caregivers’ LW completion and that of care-recipients. The results show that there is a significant relationship between the two variables: χ2 (1, n = 44) = 8.84, p &lt; .001, φ = .49. These findings suggest that secondary experiences with close one’s ACP may serve as facilitator to one’s ACP completion. Therefore, efforts to promote ACP should target a caregiver and care-recipient dyad so that caregivers as well as care-recipients may learn about and complete ACP documents.

scholarly journals Engagement in Advance Care Planning: The Association With Cognitive Impairment and Care Preferences

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 417-418
Author(s):  
Hyo Jung Lee ◽  
Giyeon Kim
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Relative Risk ◽  
End Of Life ◽  
Advance Care Planning ◽  
Multinomial Logistic Regression ◽  
Quality Care ◽  
Care Planning ◽  
Advance Care ◽  
Four Levels

Abstract Although there has been growing evidence that Advance care planning (ACP) benefits people with cognitive impairment nearing death, our understanding about this issue is still limited. This study examines whether cognitive impairment is associated with ACP engagement and end-of-life care preferences among older adults in the U.S. Using data from the 2012 National Health and Trends Study (n=1798, aged 65 to 101), we identified four levels of ACP engagement: None (28%), Informal ACP conversation only (12%), Formal ACP only (14%), and Both informal and formal ACP (46%). Older adults with None showed the highest prevalence of having cognitive impairment (17%), followed by those with Formal ACP only (15%) and the other two (6%, 6%). The results of Multinomial Logistic Regression showed that, compared to those without, respondents with cognitive impairment had 143% increased relative risk of having None (RR = 2.43, CI: 1.58-3.73) and 81% increased relative risk of completing Formal ACP only (RR = 1.81, CI: 1.11-2.95) relative to completing Both informal and formal ACP. In addition, respondents with None were more likely to prefer to receive all treatments available nearing death than those with any ACP engagement. Achieving high quality care at the end of life can be more challenging for older adults with cognitive impairment and their family caregivers due to the limited capacity. Although encouraged, informal ACP conversation with loved ones does not necessarily occur before the formal ACP, especially, for those with cognitive impairment. Therefore, they may merit more attention such as early ACP engagement.

The PREPARE for Your Care program increases advance care planning engagement among diverse older adults with cancer

Cancer ◽  
2021 ◽  
Author(s):  
Sarah S. Nouri ◽  
Deborah E. Barnes ◽  
Ying Shi ◽  
Aiesha M. Volow ◽  
Nikita Shirsat ◽  
...  
Keyword(s):  
Older Adults ◽  
Advance Care Planning ◽  
Care Program ◽  
Care Planning ◽  
Advance Care
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