Factors Influencing Advance Care Planning Among Older Adults in Two Socioeconomically Diverse Living Communities

Abstract

Background/Objectives: Advance care planning (ACP) is an iterative, complex, and dynamic process of discussion, decisionmaking, and documentation about end-of-life care. The extent to which this process takes place in older adults in diverse socioeconomic settings is not well documented. The aim of this study was to assess the knowledge, attitudes, and beliefs about ACP among older adults in two socioeconomically diverse settings to identify the individual and contextual factors that influence behaviors regarding end-of-life care. Design: A cross-sectional survey design was used. Setting: An affordable independent continuing care retirement community and a high-income eligible (HIE) independent continuing care retirement community. Participants: Individuals aged 55 years and older who resided in independent living. Measurements: A 61-item survey was administered. Simple descriptive statistics were used to examine the responses, and inferential statistics were used to evaluate which items were associated with key outcomes between the 2 settings. Results: Seventy-seven older adults completed the survey. Significant differences in familiarity of terminology and knowledge of ACP, as well as significant differences in completion of advance directives and communication, were found between the 2 communities. No differences were found in attitudes and beliefs about end-of-life issues. Conclusion: Higher levels of knowledge and engagement in ACP were reported at the HIE community as compared to the affordable housing community. These findings provide insight into the influence of the contextual forces that encourage and support ACP.

Advance care planning dispositions: the relationship between knowledge and perception

“…Attention should be paid to the vocabulary used when communicating about AD and LPOA, but also to the one employed in pre-prepared forms. Furthermore familiarity with specialized terms might differ from one socioeconomic group to another [30].…”

An Individual Housing-Based Socioeconomic Status Measure Predicts Advance Care Planning and Nursing Home Utilization

“…A study by Tripken et al 13 demonstrated that those of low SES were likely to be less familiar with Advance Care Planning (ACP) and may be less likely to complete and ACP. 13 Carr et al noted that SES might mediate lower rates of ACP planning. 14 Khosla’s longitudinal study that used income and education as predictors of ACP did not support these findings.…”

Psychometric Testing of the Korean Version of the Attitudes toward the Advance Directives in Low-Income Chronically Ill Older Adults

“…Use of ADs or ACP can result in several positive health outcomes, including less use of aggressive treatments, more patient and caregiver satisfaction, and reduced unnecessary costs [18,19]. Despite the recommendations for ACP or written ADs in malignancy and nonmalignancy settings and their positive health outcomes, access to ADs is still considerably limited to the public or nonmalignancy contexts [20][21][22][23] and people with low financial status [24][25][26]. For instance, only approximately 26% of American adults and only 12.7% of admitted patients with heart failure have documented ADs [22,27].…”

“…Approximately 41% of community-dwelling elderly had both a health care proxy and a living will [28]. A lack of or limited access to ACP and/or ADs led to poor quality of care among the financially vulnerable older adults [24][25][26]. Thus, use of ADs need to be improved.…”

“…For example, use of ADs and ACP was poorer in cancer patients with low incomes compared to that in those with high incomes [34]. The level of knowledge regarding ADs and ACP in community-dwelling older adults with low incomes was also lower than that in those with high incomes [26], which may affect completion of ADs or EOL discussion [35]. Culture has also been associated with individuals' EOL values and preferences, such as attitudes toward ADs [36][37][38].…”