Prevalence and predictors of advance directives in <scp>A</scp>ustralia

White, Benjamin P.; Tilse, Cheryl; Wilson, Jill; Rosenman, Linda; Strub, Tanya; Feeney, Rachel; Silvester, William

doi:10.1111/imj.12549

Cited by 92 publications

(111 citation statements)

References 13 publications

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“…Regarding the U.S. general adult population, a current study from Rao et al [34] analyzed data from n = 7946 participants (aged 18+ years) from a national mail survey conducted in 2009/2010. Results showed an ADs completion rate of 26.3%, a rate that is similar to the rate reported for the German general adult population by the above mentioned telephone surveys [12, 14]) but higher than, for example, the rate that was currently observed for the Australian general adult population (14.4%; data derived from a national telephone survey conducted in 2012; n = 2405 [5]). Regarding the older population in particular, Rao et al [34] reported an ADs completion rate of 51.2% for American adults aged 65 years and older.…”

Section: Discussionsupporting

confidence: 76%

“…The same holds true for a power of attorney (POA) for health care authorizing other persons to make medical decisions if an individual is temporarily or permanently unable to make own decisions (e.g. [2–5]). Both ADs and POA for health care are, moreover, part of the broader topic of advance care planning (ACP), “[…] a wider process including, for example, ongoing conversations between the competent adult and their family and health professionals about goals of future care.” (White et al [5]; page 975).…”

Section: Introductionmentioning

confidence: 99%

“…[2–5]). Both ADs and POA for health care are, moreover, part of the broader topic of advance care planning (ACP), “[…] a wider process including, for example, ongoing conversations between the competent adult and their family and health professionals about goals of future care.” (White et al [5]; page 975). In general, offering ACP conversations is encouraged by promising findings demonstrating that the implementation of systematic ACP approaches can help to increase the prevalence as well as the quality of ADs [6, 7], and shows relevant clinical effects.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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BackgroundCompletion of advance directives (ADs) and power of attorney (POA) documents may protect a person’s autonomy in future health care situations when the individual lacks decisional capacity. As such situations become naturally much more common in old age, we specifically aimed at providing information on (i) the frequency of ADs/POA in oldest-old individuals and (ii) factors associated with having completed ADs/POA.MethodsWe analyzed data of oldest-old primary care patients (85+ years; including community-dwelling and institutionalized individuals) within the German AgeQualiDe study. Patients were initially recruited via their general practitioners (GPs). We calculated frequencies of ADs and POA for health care with 95% confidence intervals (CI) and used multivariable logistic regression analysis to evaluate the association between having ADs and POA and participants’ socio-demographic, cognitive, functional, and health-related characteristics.ResultsAmong 868 GP patients participating in AgeQualiDe (response = 90.9%), n = 161 had dementia and n = 3 were too exhausted/ill to answer the questions. Out of the remaining 704 (81.1%) dementia-free patients (mean age = 88.7 years; SD = 3.0), 69.0% (95%-CI = 65.6–72.4) stated to having ADs and 64.6% (95%-CI = 61.1–68.2) to having a POA for health care. Individual characteristics did not explain much of the variability of the presence/absence of ADs and POA (regression models: Nagelkerke’s R2 = 0.034/0.051). The most frequently stated reasons for not having ADs were that the older adults trust their relatives or physicians to make the right decisions for them when necessary (stated by 59.4% and 44.8% of those without ADs). Among the older adults with ADs, the majority had received assistance in its preparation (79.0%), most frequently from their children/grandchildren (38.3%). Children/grandchildren were also the most frequently stated group of designated persons (76.7%) for those with a POA for health care.ConclusionsOur findings suggest a high dissemination of ADs and POA for health care in the oldest-old in Germany. Some adults without ADs/POA perhaps would have completed advance care documents, if they had had received more information and support. When planning programs to offer advanced care planning to the oldest old, it might be helpful to respond to these specific needs, and also to be sensitive to attitudinal differences in this target group.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…The prevalence of AD in Australia was about 14% in one study, [1] and in a population in Canada, the prevalence of AD was 43.6% [2]. About a third of USA population have an AD [3].…”

Section: Introductionmentioning

confidence: 99%

Factors that influence advance directives completion amongst terminally ill patients at a tertiary hospital in Kenya

et al. 2017

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BackgroundAn advance directive (AD) is a written or verbal document that legally stipulates a person’s health care preference while they are competent to make decisions for themselves and is used to guide decisions on life-sustaining treatment in the event that they become incapacitated. AD can take the form of a living will, a limitation of care document, a do-not-resuscitate order, or an appointment of a surrogate by durable power of attorney. The completion rate of AD varies from region to region, and it is influenced by multiple factors. The objectives of this study were to determine the proportion of terminally ill patients with AD and to identify the factors that influence the completion of AD amongst terminally ill patients at a tertiary hospital in Kenya.MethodsThe study was a retrospective survey. All available records of terminally ill patients seen at Aga Khan University Hospital, Nairobi, between July 2010 and December 2015, and that met the inclusion criteria were included in the study.ResultsIn total, 216 records of terminally ill patients were analyzed: 89 records were of patients that had AD and 127 records were of patients that did not have AD. The proportion of terminally ill patients that had completed AD was 41.2%. The factors that were associated with the completion of AD on bivariate analysis were history of ICU admission, history of endotracheal intubation, functional status of the patient, the medical specialty taking care of the patient, patient’s caregiver discussing the AD with the patient, and a palliative specialist review. On multivariate regression analysis, discussion of AD with a caregiver and patient’s functional impairment were the factors with statistically significant association with completion of AD.ConclusionsThe proportion of terminally ill patients that had AD in their medical records was significant. However, most terminally ill patients did not have AD. Our data, perhaps the first on the subject in East Africa, suggest that most of the factors associated with AD completion mirrored those seen in other regions of the world. Discussion between patient and their physician and patient’s functional impairment were the factors independently associated with completion of AD. Therefore, physicians need to be aware of the importance of discussions of AD with their patients.

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“…In Australia, with the promotion of the National Framework for Advance Care Directives, 14% of the general population over the age of 18 have now prepared ACP documents, although marked variation exists across states [14]. Recent research in one metropolitan Australian city found that 27% of nursing home residents (mean 86.2 years) had documented ACPs [15].…”

Section: Introductionmentioning

confidence: 99%

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

2017

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BackgroundCommunity-dwelling consumers of healthcare are increasing, many aging with life-limiting conditions and deteriorating cognition. However, few have had advance care planning discussions or completed documentation to ensure future care preferences are acted upon. This study examines the awareness, attitudes, and experiences of advance care planning amongst older people and unrelated offspring/caregivers of older people residing in the community.MethodsQualitative descriptive research, which included focus groups with older people (55+ years) and older people’s offspring/caregivers living in an Australian city and surrounding rural region. Data was analysed using an inductive and comparative approach. Sampling was both convenience and purposive. Participants responded to web-based, newsletter or email invitations from an agency, which aims to support healthcare consumers, a dementia support group, or community health centres in areas with high proportions of culturally and linguistically diverse community-dwellers.ResultsEight focus groups were attended by a homogenous sample of 15 older people and 27 offspring/caregivers, with 43% born overseas. The overarching theme, ‘shades of grey’: struggles in transition, reflects challenges faced by older people and their offspring/caregivers as older people often erratically transition from independence and capacity to dependence and/or incapacity. Offspring/caregivers regularly struggled with older people’s fluctuating autonomy and dependency as older people endeavoured to remain at home, and with conceptualising “best times” to actualise advance care planning with substitute decision maker involvement. Advance care planning was supported and welcomed, x advance care planning literacy was evident. Difficulties planning for hypothetical health events and socio-cultural attitudes thwarting death-related discussions were emphasised. Occasional offspring/caregivers with previous substitute decision maker experience reported distress related to their decisions.ConclusionsAdvance care planning programs traditionally assume participants are ‘planning ready’ to legally appoint a substitute decision maker (power of attorney) and record end-of-life treatment preferences in short time frames. This contrasts with how community dwelling older people and offspring/caregivers conceive future care decisions over time. Advance care planning programs need to include provision of information, which supports older people’s advance care planning understanding and management, and also supports offspring/caregivers’ development of strategies for broaching advance care planning with older people, and preparing for potential substitute decision maker roles. Development and integration of strategies to support older people’s decision-making when in the ‘grey zone’, with fluctuating cognitive capacities, needs further consideration. Findings support an advance care planning model with conversations occurring at key points across a person’s lifespan.

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Prevalence and predictors of advance directives in Australia

Cited by 92 publications

References 13 publications

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

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

Factors that influence advance directives completion amongst terminally ill patients at a tertiary hospital in Kenya

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

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