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

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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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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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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Advance Care Planning and the Quality of End-of-Life Care in Older Adults

Journal of the American Geriatrics Society ◽

10.1111/jgs.12105 ◽

2013 ◽

Vol 61 (2) ◽

pp. 209-214 ◽

Cited By ~ 192

Author(s):

Kara E. Bischoff ◽

Rebecca Sudore ◽

Yinghui Miao ◽

Walter John Boscardin ◽

Alexander K. Smith

Keyword(s):

Older Adults ◽

End Of Life ◽

Advance Care Planning ◽

End Of Life Care ◽

Care Planning ◽

Life Care ◽

Advance Care

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Asian collaboration to establish a provisional system to provide high-quality end-of-life care by promoting advance care planning for older adults

Geriatrics and Gerontology International ◽

10.1111/ggi.12902 ◽

2017 ◽

Vol 17 (3) ◽

pp. 522-524

Author(s):

Kazuyoshi Senda ◽

Mitsunori Nishikawa ◽

Yuko Goto ◽

Hisayuki Miura

Keyword(s):

Older Adults ◽

End Of Life ◽

Advance Care Planning ◽

End Of Life Care ◽

Care Planning ◽

Life Care ◽

High Quality ◽

Advance Care

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Unraveling the Effects of Social Class and Systemic Racism on Advance Care Planning

Innovation in Aging ◽

10.1093/geroni/igaa057.1528 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 472-472

Author(s):

Jenny McDonnell

Keyword(s):

End Of Life ◽

Advance Care Planning ◽

End Of Life Care ◽

Black Americans ◽

Low Ses ◽

Care Planning ◽

Life Care ◽

Black And White ◽

Advance Care ◽

Using Data

Abstract While advance care planning (ACP) is recognized as a key facilitator of high-quality, goal-concordant end-of-life care, black Americans are less likely to participate in ACP than non-Hispanic whites (Carr 2011; Detering et al. 2010). There are divided explanations for why these disparities persist. Some scholars attribute racial disparities in end-of-life care to socioeconomic (SES) differences between black and white Americans citing blacks’ and whites’ differentiated access to, control over, and use of material resources (Wilson 1978; Yearby 2011). Others assert that health care preferences do not solely reflect lack of resources or health literacy, but that the larger social context frames care preferences differently across racial and ethnic groups in American society (Alegria et al. 2011; Sewell and Pingel forthcoming). By turning the analytical lens to class-privileged black Americans, I investigate whether racism overflows the margins of class disadvantage. Using data from the Health and Retirement Study, I ran logistic regression and moderation models. I found that class-privileged blacks are less likely to engage in ACP than both high-SES and low-SES whites. The interaction of race and SES was negatively and significantly associated with ACP (OR=0.91; P<0.05), indicating that SES has a stronger effect on the probability of ACP among whites than among blacks. Predicted probabilities show that 51% of low-SES whites are likely to engage in ACP compared to 32% of high-SES blacks. These findings indicate that racialized disparities in ACP exist independent of SES, and that the effects of SES and race are intersectional rather than simply additive.

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