P36 Development of the STADPLAN intervention on advance care planning in care dependent community-dwelling older persons in germany

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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Advance Care Planning in Community-Dwelling Patients With Dementia

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2017.12.473 ◽

2018 ◽

Vol 55 (4) ◽

pp. 1105-1112 ◽

Cited By ~ 14

Author(s):

Jane L. Givens ◽

Rebecca L. Sudore ◽

Gad A. Marshall ◽

Alyssa B. Dufour ◽

Ilona Kopits ◽

...

Keyword(s):

Advance Care Planning ◽

Community Dwelling ◽

Care Planning ◽

Advance Care

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Advance Care Planning Engagement Among Muslim Community-Dwelling Adults Living in the United States

Journal of Hospice and Palliative Nursing ◽

10.1097/njh.0000000000000690 ◽

2020 ◽

Vol 22 (6) ◽

pp. 479-488

Author(s):

Ghaith A. Bani Melhem ◽

Debra C. Wallace ◽

Judith A. Adams ◽

Ratchneewan Ross ◽

S. Sudha

Keyword(s):

United States ◽

Advance Care Planning ◽

The United States ◽

Community Dwelling ◽

Care Planning ◽

Muslim Community ◽

Advance Care

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ADVANCE CARE PLANNING IN DIVERSE COMMUNITY-DWELLING ADULTS THROUGH STUDENT/FACULTY PARTNERSHIPS

The Gerontologist ◽

10.1093/geront/gnv561.02 ◽

2015 ◽

Vol 55 (Suppl_2) ◽

pp. 226-226 ◽

Cited By ~ 1

Keyword(s):

Advance Care Planning ◽

Community Dwelling ◽

Care Planning ◽

Advance Care ◽

Diverse Community

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Advance Care Planning (ACP) vs. Advance Serious Illness Preparations and Planning (ASIPP)

Healthcare ◽

10.3390/healthcare8030218 ◽

2020 ◽

Vol 8 (3) ◽

pp. 218 ◽

Cited By ~ 1

Author(s):

Daren K. Heyland

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Advance Care Planning ◽

Older Persons ◽

Clinical Decision Making ◽

Past Research ◽

Care Planning ◽

Shared Decision ◽

Serious Illness ◽

Advance Care

COVID-19 has highlighted the reality of an impending serious illness for many, particularly for older persons. Those faced with severe COVID-19 infection or other serious illness will be faced with decisions regarding admission to intensive care and use of mechanical ventilation. Past research has documented substantial medical errors regarding the use or non-use of life-sustaining treatments in older persons. While some experts advocate that advance care planning may be a solution to the problem, I argue that the prevailing understanding and current practice of advance care planning perpetuates the problem and results in patients not receiving optimal patient-centered care. Much of the problem centers on the framing of advance care planning around end of life care, the lack of use of decision support tools, and inadequate language that does not support shared decision-making. I posit that a new approach and new terminology is needed. Advance Serious Illness Preparations and Planning (ASIPP) consists of discrete steps using evidence-based tools to prepare people for future clinical decision-making in the context of shared decision-making and informed consent. Existing tools to support this approach have been developed and validated. Further dissemination of these tools is warranted.

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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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