Association between social networks and discussions regarding advance care planning among Japanese older adults

Abstract

BackgroundOlder adults’ discussions with family, or with physicians, or with both, about advance care planning (ACP) are increasingly regarded as important for the management of end-of-life care, and yet the factors that induce older adults to engage in ACP discussions are poorly understood. For example, in older adults, is stronger connectedness with family and friends (stronger “networks”) associated with ACP discussions? By facilitating, or by impeding ACP discussions? We sought to evaluate the associations between ACP discussions and social networks in Japanese older adults.MethodsIn July 2016 we conducted a cross-sectional survey on 355 community-dwelling patients aged ≥65 years visiting community hospital clinics in Fukushima, Japan. We used the Lubben Social Network Scale (LSNS-6, the shortest available LSNS scale) to assess social networks and recorded two components of social network structure, marital status (dichotomized as “married” vs. “single / other”) and living status (“living with others” vs. “living alone”). One item asked if patients had had ACP discussions. We analyzed the LSNS-6 social network and marital and living status data in relation to the occurrence of ACP discussions using multiple logistic regression models with adjustments for possible confounding factors.ResultsRespondents’ social network was “limited” in 16% of cases; 61% had had ACP discussions. Respondents with a limited social network had a significantly lower tendency to have had ACP discussions than respondents with an “adequate” social network (adjusted odds ratio [AOR]: 0.35; 95% confidence interval [CI]: 0.18–0.66; P < 0.001). Marital status and living status were not significantly associated with ACP discussion.ConclusionsAmong Japanese older adults, weaker social networks may be associated with a lower tendency to discuss ACP. Our findings may help practitioners to quickly screen populations at risk for inadequate ACP discussion by using the LSNS-6.

Advance Care Planning: Social Isolation Matters

“…A recently published study from a single center in Japan (N = 355) found that weaker social networks (measured by the LSNS‐6) were associated with a lower tendency to have ACP discussions . Prior to the aforementioned study and ours, others have not directly examined the role of social isolation on ACP using nationally representative data .…”

“…A recently published study from a single center in Japan (N = 355) found that weaker social networks (measured by the LSNS-6) were associated with a lower tendency to have ACP discussions. 24 Prior to the aforementioned study and ours, others have not directly examined the role of social isolation on ACP using nationally representative data. 5,17 Sudore et al reported social isolation explained why older study participants were less likely to engage in discussion with family or friends and suggest that socially isolated individuals may require "special attention and resources".…”

Determinants of ADL and IADL disability in older adults in southeastern Poland

“…Micheli et al found that respondents with worse family relations had a higher risk of functional limitations [61]. It is important to develop a network of contacts and build social relations among older persons to arouse their motivation to be active and participate in neighborly assistance [62].…”

Patients’ preferences and factors influencing initial advance care planning discussions’ timing: A cross-cultural mixed-methods study

“…3 Thus, Japanese older adults feel a need to discuss advance care planning to address this discordance. 4 In Japan, the prevalence of discussions approximately doubled from the second half of the 2000s (around 20% in both middle-aged and older adults) 5,6 to the second half of the 2010s (35% in middle-aged adults; 47% in older adults). 7 Although Japan still lacks legislation mandating advance care planning or advance directives, the doubled prevalence is perhaps attributable to rapid growth in the senior population and interest in patient autonomy at end of life.…”