AWARENESS OF ADVANCE CARE PLANNING AND ADVANCE DIRECTIVE AMONG OLDER ADULTS IN JAPAN, HONG KONG, AND KOREA

Background: The importance of advance care planning (ACP) discussions have been heightened during the COVID-19 pandemic. We assessed advance directive completion, healthcare proxy (HCP), and attitudes toward ACP among older adults ages 50+ living with HIV during the COVID-19 pandemic.Methods: Internet-based surveys were administered to 100 participants residing in the Coachella Valley, California from April to June 2020. We examined self-reported completion of an advance directive, HCP, and attitudes toward ACP before and after COVID-19. Adjusted regressions were performed on attitudes toward ACP.Results: Participants' mean age was 64.2 years, most were non-Hispanic white (88.0%), men (96.0%), and identified as sexual minorities (96.0%). Many reported having an advance directive (59.6%) or HCP (67.3%). Most (57.6%) believed ACP to be more important now compared to the pre-pandemic era. Having an advance directive was associated with increase in age, higher education, living with other people, never having an AIDS diagnosis, and current undetectable viral load (p < 0.05). Having a HCP was associated with higher education, being married/partnered, and living with other people (p < 0.05). In a logistic regression model adjusted for education and living situation, the belief that ACP was more important during COVID was associated with not having an advance directive (OR: 5.07, 95% CI: 1.78–14.40) and fear of COVID-19 infection (OR: 4.17, 95% CI: 1.61–10.76.)Conclusions: The COVID-19 pandemic presents a window of opportunity to engage people aging with HIV in ACP discussions, particularly those who do not already have an advance directive.

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SHARING Choices: A Pilot Study to Engage Family in Advance Care Planning of Older Adults With and Without Cognitive Impairment in the Primary Care Context

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120978771 ◽

2020 ◽

pp. 104990912097877

Author(s):

Jennifer L. Wolff ◽

Danny Scerpella ◽

Kimberly Cockey ◽

Naaz Hussain ◽

Tara Funkhouser ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Cognitive Impairment ◽

Advance Care Planning ◽

Advance Directive ◽

Agenda Setting ◽

Care Planning ◽

Future Care ◽

Advance Care ◽

Electronic Health Information

Context: Few advance care planning (ACP) interventions proactively engage family or address the needs of older adults with and without cognitive impairment in the primary care context. Objectives: To pilot a multicomponent intervention involving: an introductory letter describing a new clinic initiative and inviting patients to complete a patient-family pre-visit agenda-setting checklist, share their electronic health information with family, and talk about their wishes for future care with a trained ACP facilitator (SHARING Choices). Methods: SHARING Choices was delivered to 40 patient-family dyads from 3 primary care clinics. Facilitators completed post-ACP reports. Patient and family participants completed baseline and 6-week surveys. Results: Patients were on average 75 years (range 65-90). Family were spouses (85.0%) or adult children (15.0%). At 6 weeks, nearly half of dyads participated in ACP conversations (n = 19) or used the agenda-setting checklist (n = 17), one-third (n = 13) registered family to access the patient’s portal account, and most (n = 28) provided the primary care team with a new or previously completed advance directive. Of 12 patients who screened positive for cognitive impairment, 9 completed ACP conversations and 10 provided the clinic with an advance directive. ACP engagement, measured on a 4-point scale, was comparatively lower at baseline and 6 weeks among family (3.05 and 3.19) than patients (3.56 and 3.54). Patients remarked that SHARING Choices clarified communication and preferences while family reported a better understanding of their role in ACP and communication. Conclusion: SHARING Choices was acceptable among older adults with and without cognitive impairment and may increase advance directive completion.

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Preparing Spanish-speaking Older Adults for Advance Care Planning and Medical Decision-Making—The PREPARE Trial

10.25302/05.2020.cdr.130601500 ◽

2020 ◽

Author(s):

Rebecca Sudore ◽

Dean Schillinger ◽

Aiesha Volow ◽

Ying Shi ◽

John Boscardin ◽

...

Keyword(s):

Older Adults ◽

Decision Making ◽

Advance Care Planning ◽

Medical Decision Making ◽

Medical Decision ◽

Care Planning ◽

Spanish Speaking ◽

Advance Care

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

Innovation in Aging ◽

10.1093/geroni/igaa057.1347 ◽

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.

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