Advance care directive prevalence among older Australians and associations with person‐level predictors and quality indicators

Abstract

Background Advance care planning (ACP) conversations may result in preferences for medical care being documented. Objective To explore the uptake and quality of advance care directives (ACDs) among older Australians accessing health and aged care services, by overall ACP documentation prevalence, person‐level predictors and ACD quality indicators. Design and Setting National multi‐centre health record audit in general practices (GP), hospitals and residential aged care facilities (RACF). Participants A total of 4187 people aged ≥65 years attending their GP (n = 676), admitted to hospital (n = 1122) or residing in a RACF (n = 2389). Main Outcome Measures ACP documentation prevalence by setting and type including person‐completed ACDs and non‐ACD documents (completed by a health professional or someone else); person‐level predictors and quality indicators of ACDs. Results Overall ACP documentation prevalence was 46.5% (29.2% weighted). ACD prevalence was 25.3% (14.2% weighted). Unweighted ACD prevalence was higher in RACFs (37.7%) than in hospitals (11.1%) and GPs (5.5%). 35.8% of ACP documentation was completed by a health professional (9.7% weighted), and 18.1% was completed by someone else (10.6% weighted). Having an ACD was positively associated with being female, older, having two or more medical conditions, receiving palliative care, being divorced/separated and being in a RACF. Only 73% of ACDs included full name, signature, document date and witnessing. Conclusions and Contribution Low ACP documentation prevalence and a lack of accessible, person‐completed and quality ACDs represent an important ACP implementation issue. Low prevalence is complicated by poor document quality and a higher prevalence of documents being completed by someone other than the person.

Factors Associated with Advance Directives Documentation: A Nationwide Cross-Sectional Survey of Older Adults in Korea

“…Previous studies have reported that being female and widowed are predictors of ADs among older adults [ 14 , 15 , 24 ]; however, no such associations were found in our study. Since other studies have also reported no associations between ADs and gender or marital status [ 17 , 25 , 26 , 27 ], further research on sociodemographic factors is needed.…”

“…Older adults with chronic diseases were more likely to have ADs than those without, which is consistent with the results of previous studies [ 3 , 14 ]. Older patients with comorbidities were more likely to have had prior discussions with their healthcare providers regarding their preference for EOL care [ 14 , 28 ]. Chronic diseases are characterized by a large burden of care because of their prolonged duration.…”

“…This accounted for approximately 5.6% of the total number of individuals in the same age range, which is comparable to the results of our study. The prevalence of AD found in our study was relatively lower than that in the United States (46–51%) [ 13 ] or Australia (14%) [ 14 ], which is noteworthy because it resulted from two years of legislation on AD documentation in Korea.…”

Prevalence and correlates of advance care planning among Australian hospital inpatients

“…To our knowledge, this is the largest population‐level study identifying the prevalence of ACP documents among acute hospital inpatients. Prevalence statistics are lower compared to similar studies and may be explained by deficiencies in the uptake of ACP documents across both community and acute healthcare settings and exacerbated by low communication of such documents between these sectors 13–15 . Appropriate storage of ACP documents in hospital records is important to ensure that they are readily available to be referred to if a patient loses decision‐making capacity.…”

“…Prevalence statistics are lower compared to similar studies and may be explained by deficiencies in the uptake of ACP documents across both community and acute healthcare settings and exacerbated by low communication of such documents between these sectors. [13][14][15] Appropriate storage of ACP documents in hospital records is important to ensure that they are readily available to be referred to if a patient loses decision-making capacity. The applicability of previous prevalence studies is impacted by their focus on smaller population subgroups with an anticipatedly higher prevalence of ACP documents, such as individuals with life-limiting illnesses.…”