FACTORS AFFECTING OLDER ADULTS’ ADVANCE CARE PLANNING, END-OF-LIFE CONCERNS AND HOSPICE KNOWLEDGE

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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Association of Experience with Illness and End-of-life Care with Advance Care Planning in Older Adults

Journal of the American Geriatrics Society ◽

10.1111/jgs.12894 ◽

2014 ◽

Vol 62 (7) ◽

pp. 1304-1309 ◽

Cited By ~ 27

Author(s):

Halima Amjad ◽

Virginia Towle ◽

Terri Fried

Keyword(s):

Older Adults ◽

End Of Life ◽

Advance Care Planning ◽

End Of Life Care ◽

Care Planning ◽

Life Care ◽

Advance Care

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IMPROVING END-OF-LIFE CARE AND ADVANCE CARE PLANNING FOR FRAIL OLDER ADULTS IN CANADA

Journal of Frailty & Aging ◽

10.14283/jfa.2018.33 ◽

2018 ◽

pp. 1-7

Author(s):

J. Downar ◽

P. Moorhouse ◽

R. Goldman ◽

D. Grossman ◽

S. Sinha ◽

...

Keyword(s):

Older Adults ◽

Palliative Care ◽

End Of Life ◽

Advance Care Planning ◽

End Of Life Care ◽

Care Planning ◽

Life Care ◽

Frail Older Adults ◽

Key Concepts ◽

Advance Care

We present five Key Concepts that describe priorities for improving end-of-life care for frail older adults in Canada, and recommendations based on each Key Concept. Key Concept #1: Our end-of-life care system is focused on cancer, not frailty. Key Concept #2: We need better strategies to systematically identify frail older adults who would benefit from a palliative approach. Key Concept #3: The majority of palliative and end-of-life care will be, and should be, provided by clinicians who are not palliative care specialists. Key Concept #4: Organizational change and innovative funding models could deliver far better end-of-life care to frail individuals for less than we are currently spending. Key Concept #5: Improving the quality and quantity of advance care planning for frail older adults could reduce unwanted intensive care and costs at the end of life, and improve the experience for individuals and family members alike.

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Advance care planning among older LGBT Canadians: Heteronormative influences

Sexualities ◽

10.1177/1363460719896968 ◽

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.

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Factors Influencing Advance Care Planning Among Older Adults in Two Socioeconomically Diverse Living Communities

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909116679140 ◽

2016 ◽

Vol 35 (1) ◽

pp. 69-74 ◽

Cited By ~ 9

Author(s):

Jennifer L. Tripken ◽

Cathy Elrod ◽

Susan Bills

Keyword(s):

Older Adults ◽

End Of Life ◽

Advance Care Planning ◽

End Of Life Care ◽

Retirement Community ◽

Continuing Care ◽

Care Planning ◽

Attitudes And Beliefs ◽

Life Care ◽

Advance Care

Background/Objectives: Advance care planning (ACP) is an iterative, complex, and dynamic process of discussion, decision-making, and documentation about end-of-life care. The extent to which this process takes place in older adults in diverse socioeconomic settings is not well documented. The aim of this study was to assess the knowledge, attitudes, and beliefs about ACP among older adults in two socioeconomically diverse settings to identify the individual and contextual factors that influence behaviors regarding end-of-life care. Design: A cross-sectional survey design was used. Setting: An affordable independent continuing care retirement community and a high-income eligible (HIE) independent continuing care retirement community. Participants: Individuals aged 55 years and older who resided in independent living. Measurements: A 61-item survey was administered. Simple descriptive statistics were used to examine the responses, and inferential statistics were used to evaluate which items were associated with key outcomes between the 2 settings. Results: Seventy-seven older adults completed the survey. Significant differences in familiarity of terminology and knowledge of ACP, as well as significant differences in completion of advance directives and communication, were found between the 2 communities. No differences were found in attitudes and beliefs about end-of-life issues. Conclusion: Higher levels of knowledge and engagement in ACP were reported at the HIE community as compared to the affordable housing community. These findings provide insight into the influence of the contextual forces that encourage and support ACP.

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FAMILY CAREGIVERS’ ADVANCE CARE PLANNING FOR COGNITIVELY IMPAIRED OLDER ADULTS: SERVICE PROVIDERS’ PERSPECTIVES

Innovation in Aging ◽

10.1093/geroni/igz038.884 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S237-S237

Author(s):

Hyunjin Noh ◽

Temilade A Aladeokin

Keyword(s):

Older Adults ◽

End Of Life ◽

Family Caregivers ◽

Advance Care Planning ◽

Service Providers ◽

Cognitively Impaired ◽

Care Planning ◽

Barriers To Access ◽

Advance Care ◽

Surrogate Decision

Abstract An increasing number of family caregivers face challenges of advance care planning (ACP) for their cognitively impaired older adults. The purpose of this study was to understand service providers’ views of ACP knowledge and needs among such family caregivers. Purposive sampling was used to recruit 10 service providers who serve older adults and their family caregivers in community settings of West Alabama. Individual, face-to-face interviews were conducted guided by a semi-structured questionnaire, asking about their experiences with and views of family caregivers’ ACP for their older adults. Thematic analysis of the qualitative data revealed several findings: family caregivers’ lack of knowledge about ACP and end-of-life care, discomfort in end-of-life discussions, uncertainty about their older adult’s end-of-life preferences, frustration with the surrogate decision-making role, family conflicts in ACP process, and logistical barriers to access ACP resources. Tailored services should be developed to address these barriers to promote ACP among this population.

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Acceptability of Paper-Based Advance Care Planning (ACP) to Inform End-of-Life Care Provision for Community Dwelling Older Adults: A Qualitative Interview Study

Geriatrics ◽

10.3390/geriatrics3040088 ◽

2018 ◽

Vol 3 (4) ◽

pp. 88 ◽

Cited By ~ 1

Author(s):

Gary Bellamy ◽

Jennifer Stock ◽

Patricia Schofield

Keyword(s):

Older Adults ◽

End Of Life ◽

Advance Care Planning ◽

End Of Life Care ◽

Community Dwelling ◽

Care Planning ◽

Care Provision ◽

Life Care ◽

Telephone Interviews ◽

Advance Care

This paper reports the findings from a study to investigate health care professionals’ views regarding the use and acceptability of two similar paper-based advance care planning (ACP) documents designed for older adults in their last year of life to inform end-of-life care provision. Participants’ views of using PEACE (Proactive Elderly Persons Advisory Care), a nurse led model with community geriatrician oversight, and PACe (proactive anticipatory care plan), a general practitioner (GP) led model implemented by two clinical commissioning groups (CCGs) as part of a wider pilot to determine their ability to improve end-of-life care provision, were explored. Hospital admission avoidance matrons took part in face to face interviews and care staff employed in private residential care homes took part in individual telephone interviews to explore their views of using the PEACE tool. Telephone interviews were conducted with GPs to explore their views of PACe. GPs and admission avoidance matrons were employed by CCGs and all study participants were recruited from the South East of England, where data collection took place in 2015. The data were analysed thematically. Findings from the study demonstrate how both tools provide a focus to ACP discussions to inform individual end-of-life care preferences. The importance of relationships was a pivotal theme established, trusting inter-professional relationships to enable multidisciplinary teamwork and a prior relationship with the older person (or their proxy in the case of cognitive impairment) to enable such conversations in the first place. Both tools enabled participants to think critically and reflect on their own practice. Notwithstanding participants’ views to improve their layout, using a paper-based approach to deliver streamlined ACP and end-of-life care was a theme to emerge as a potential barrier, and highlighted problems with accessing paper-based documentation, accuracy and care co-ordination in the context of multidisciplinary team working. The value of technology in overcoming this barrier and underpinning ACP as a means to help simplify service provision, promote integrated professional practice and provide seamless care, was put forward as a way forward.

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