Advance care planning for older people in Australia presenting to the emergency department from the community or residential aged care facilities

Abstract

The purpose of this retrospective, cross-sectional study was to determine the prevalence of advance care planning (ACP) among older people presenting to an Emergency Department (ED) from the community or a residential aged care facility. The study sample comprised 300 older people (aged 65+ years) presenting to three Victorian EDs in 2011. A total of 150 patients transferred from residential aged care to ED were randomly selected and then matched to 150 people who lived in the community and attended the ED by age, gender, reason for ED attendance and triage category on arrival. Overall prevalence of ACP was 13.3% (n = 40/300); over one-quarter (26.6%, n = 40/150) of those presenting to the ED from residential aged care had a documented Advance Care Plan, compared to none (0%, n = 0/150) of the people from the community. There were no significant differences in the median ED length of stay, number of investigations and interventions undertaken in ED, time seen by a doctor or rate of hospital admission for those with an Advance Care Plan compared to those without. Those with a comorbidity of cerebrovascular disease or dementia and those assessed with impaired brain function were more likely to have a documented Advance Care Plan on arrival at ED. Length of hospital stay was shorter for those with an Advance Care Plan [median (IQR) = 3 days (2-6) vs. 6 days (2-10), P = 0.027] and readmission lower (0% vs. 13.7%). In conclusion, older people from the community transferred to ED were unlikely to have a documented Advance Care Plan. Those from residential aged care who were cognitively impaired more frequently had an Advance Care Plan. In the ED, decisions of care did not appear to be influenced by the presence or absence of Advance Care Plans, but length of hospital admission was shorter for those with an Advance Care Plan.

Prevalence of advance care directives in the community: a telephone survey of three Australian States

“…A South Australian study found a community prevalence of 12% for instructional ACD in that State and 13 and 11% respectively for two types of appointing ACD (enduring powers of guardianship and medical powers of attorney) . Other research has focused on ACD completion in particular settings, such as residential aged care and hospital . There is also limited and inconclusive research on who completes ACD.…”

Managing ‘shades of grey’: a focus group study exploring community-dwellers’ views on advance care planning in older people

“…Recent research in one metropolitan Australian city found that 27% of nursing home residents (mean 86.2 years) had documented ACPs [15]. The nursing home residents’ plans were often ambiguous, difficult to interpret, and sometimes overridden [15].…”

“…Recent research in one metropolitan Australian city found that 27% of nursing home residents (mean 86.2 years) had documented ACPs [15]. The nursing home residents’ plans were often ambiguous, difficult to interpret, and sometimes overridden [15]. More recently, an Australian national government funded initiative, Decision Assist, has been promoted to promote ACP by improved linkages between aged and palliative care services via a phone advisory service [16].…”

Quantifying the Mortality Impact of Do-Not-Resuscitate Orders in the ICU*

“…Although almost 60 million Americans have a living will, explicit resuscitation directives are not common (2, 3). When such directives are in place, their effects on patient outcomes are unclear.…”