Advance directives and power of attorney for health care in the oldest-old – results of the AgeQualiDe study

Luck, Tobias; Rodriguez, Francisca S.; Wiese, Birgitt; Leeden, Carolin van der; Heser, Kathrin; Bickel, Horst; Schmitten, Jürgen in der; König, Hans‐Helmut; Weyerer, Siegfried; Mamone, Silke; Mallon, Tina; Wagner, Michael; Weeg, Dagmar; Fuchs, Ângela; Brettschneider, Christian; Werle, Jochen; Scherer, Martin; Maier, Wolfgang; Riedel‐Heller, Steffi G.

doi:10.1186/s12877-017-0482-8

Cited by 19 publications

(19 citation statements)

References 33 publications

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“…This trust was well documented in prior studies, e.g. the AgeQualiDe study showed that 28.3% of oldest old patients (≥85 years) were not interested in written documents as they believed that their GP and family members would make the right decisions for them [ 12 ]. In contrast to these long-standing relationships, external ACP facilitators would need to start from scratch and require considerably more time.…”

Section: Discussionmentioning

confidence: 60%

“…Despite these developments, the prevalence of ADs is low; in Belgium and the Netherlands, for example, 2–3% of persons aged below 60, about 10% of those aged ≥60, and up to 23% of relatives of decedents have ADs [ 10 , 11 ]. In Germany, the prevalence of ADs in the general population was between 2.5 and 10%, while a survey of GP patients ≥85 years reported that 69% have an AD and 64.6% a PA [ 12 , 13 ]. Beside notaries, general practitioners (GPs) are the preferred contact persons for discussing end-of-life issues and preparing such documents [ 14 , 15 ], yet little research has been conducted in primary care settings [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

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More counselling for end-of-life decisions by GPs with own advance directives: A postal survey among German general practitioners

Schnakenberg

Radbruch

Kersting

et al. 2018

European Journal of General Practice

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Background: Although general practitioners (GPs) are among the preferred contact persons for discussing end-of-life issues including advance directives (ADs), there is little data on how GPs manage such consultations.Objectives: This postal survey asked German GPs about their counselling for end-of-life decisions.Methods: In 2015, a two-sided questionnaire was mailed to 959 GPs. GPs were asked for details of their consultations on ADs: frequency, duration, template use, and whether they have own ADs. Statistical analysis evaluated physician characteristics associated with an above-average number of consultations on AD.Results: The participation rate was 50.3% (n = 482), 70.5% of the GPs were male; the average age was 54 years. GPs had an average of 18 years of professional experience, and 61.4% serve more than 900 patients per three months. Most (96.9%) GPs perform consultations on living wills (LW) and/or powers of attorney (PA), mainly in selected patients (72.3%). More than 20 consultations each on LWs and PAs are performed by 60% and 50% of GPs, respectively. The estimated mean duration of consultations was 21 min for LWs and 16 min for PAs. Predefined templates were used in 72% of the GPs, 50% of GPs had their ADs. A statistical model showed that GPs with ADs and/or a qualification in palliative medicine were more likely to counsel ≥20 patients per year for each document.Conclusion: The study confirmed that nearly all German GPs surveyed provide counselling on ADs. Physicians with ADs counsel more frequently than those without such documents.

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

More counselling for end-of-life decisions by GPs with own advance directives: A postal survey among German general practitioners

Schnakenberg

Radbruch

Kersting

et al. 2018

European Journal of General Practice

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“…Having an AD and advance care plan improve the quality of end-of-life care and increase the satisfaction of elderly patients and their families ( 10 ). Several studies have reported that over 50% of aged nursing home residents have an AD in the United States ( 11 , 12 ) and in Germany ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

Can the Wish to Receive Intensive Treatment in Elderly Patients with Respiratory Tract Infection Be Predicted?

et al. 2018

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Objective Almost no Japanese elderly patients have an advance directive (AD). Our aim was to determine whether or not the wish to receive intensive care in elderly patients with respiratory tract infection could be predicted from the prehospital data. Methods In this retrospective study, we reviewed patients ≥65 years of age with respiratory tract infection who had been transferred to our hospital by ambulance between September 2014 and August 2016. The patients were divided into two groups according to whether or not they wished to receive intensive treatment. We placed patients without a wish to receive intensive treatments (WITs) in Group A and patients with a WITs in Group B. We then analyzed parameters that could be determined in the prehospital phase and compared the findings between the groups. Results Thirty-seven patients were in Group A, and 67 patients were in Group B. None of the patients in this study had an AD. There were significant differences in the age, rate of residence in an extended care facility, frequency of inability to care for oneself fully, frequency of dementia, number of prescribed drugs, and Glasgow coma scale (GCS) on a univariate analysis. A logistic regression analysis showed that the inability to care for oneself fully [odds ratio (OR): 4.521, 95% confidence interval (CI): 2.024-10.096, p<0.001] and a low GCS (OR 0.885, 95%CI 0.838-0.935, p<0.001) were related to a WITs. Conclusion Elderly patients who are unable to care for themselves and who have a low GCS in the prehospital stage are likely not to want intensive treatment.

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“…; n = 726/21.8%). For further details of the Age-CoDe and AgeQualiDe study sampling, see Luck et al (2007Luck et al ( , 2017. All patients who participated in the studies provided written informed consent prior to their participation.…”

Section: Samplingmentioning

confidence: 99%

Determinants of incident dementia in different old age groups: results of the prospective AgeCoDe/AgeQualiDe study

Luck

Pabst

Röhr

et al. 2019

Int. Psychogeriatr.

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Objectives:To examine the impact of determinants of incident dementia in three different old age groups (75–79, 80–84, 85+years) in Germany.Design:Multicenter prospective AgeCoDe/AgeQualiDe cohort study with baseline and nine follow-up assessments at 1.5-year intervals.Setting:Primary care medical record registry sample.Participants:General practitioners’ (GPs) patients aged 75+years at baseline.Measurements:Conduction of standardized interviews including neuropsychological assessment and collection of GP information at each assessment wave. We used age-stratified competing risk regression models (accounting for the competing event of mortality) to assess determinants of incident dementia and age-stratified ordinary least square regressions to quantify the impact of identified determinants on the age at dementia onset.Results:Among 3027 dementia-free GP patients, n = 704 (23.3%) developed dementia during the 13-year study period. Worse cognitive performance and subjective memory decline with related worries at baseline, and the APOE ε4 allele were associated independently with increased dementia risk in all three old age groups. Worse cognitive performance at baseline was also associated with younger age at dementia onset in all three age groups. Other well-known determinants were associated with dementia risk and age at dementia onset only in some or in none of the three old age groups.Conclusions:This study provides further evidence for the age-specific importance of determinants of incident dementia in old age. Such specifics have to be considered more strongly particularly with regard to potential approaches of early detection and prevention of dementia.

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Advance directives and power of attorney for health care in the oldest-old – results of the AgeQualiDe study

Cited by 19 publications

References 33 publications

More counselling for end-of-life decisions by GPs with own advance directives: A postal survey among German general practitioners

More counselling for end-of-life decisions by GPs with own advance directives: A postal survey among German general practitioners

Can the Wish to Receive Intensive Treatment in Elderly Patients with Respiratory Tract Infection Be Predicted?

Determinants of incident dementia in different old age groups: results of the prospective AgeCoDe/AgeQualiDe study

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