Cognitive abilities and engagement in advance care planning among older adults: Results of a Swiss populational study.

Abstract

Individuals often wait until the last moment to plan their end-of-life (EOL) care. Yet, decision-making capacity decreases with age, which could compromise engagement in and the effectiveness of advance care planning (ACP). Little is known about the association between cognitive abilities and the steps involved in the multifaceted process of ACP in older adults. The present study aims to better understand the association of global cognitive competence with engagement in ACP in a nationally representative sample of older adults in Switzerland. Global cognitive competence was measured via verbal fluency, immediate and delayed memory, basic calculation skills, and temporal orientation. Engagement in ACP included approving advance directives, having discussed EOL preferences, having a living will, and having a health care proxy. We analyzed data of 1,936 respondents aged 55+ from a paper-and-pencil questionnaire that was administered as part of Wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe in Switzerland using logistic regression models. Respondents with reduced global cognitive competence are less likely to have discussed their EOL preferences with others and to have a living will. Our results also indicate an interaction between age and cognition with respect to having a living will. Individuals with lower global cognitive competence in the oldest age group-adults aged 75 and older-are less likely to have a living will. Our findings highlight that low global cognitive competence can be seen as a barrier to engagement in ACP, particularly among adults 75 years and older. Public Significance StatementAdvance care planning (ACP) is a multifaceted, continuous, and iterative process that involves various behaviors. Participation in the ACP process is cognitively demanding, especially for individuals aged 75 and older, in light of the higher likelihood of cognitive decline in this age group. Considering the substantial benefits that advance directives provide to individuals and the people around them, it is advisable to initiate the ACP process as early as possible to mitigate the potential negative impact of cognitive decline. Early engagement with the ACP process may enhance the completion of advance directives, improve its overall outcomes, facilitate the revision of these directives, and ease navigation through potential obstacles that may arise due to cognitive decline.