What Factors Are Associated With Having an Advance Directive Among Older Adults Who Are New to Long Term Care Services?

Hirschman, Karen B.; Abbott, Katherine; Hanlon, Alexandra L.; Bettger, Janet Prvu; Naylor, Mary D.

doi:10.1016/j.jamda.2010.12.010

Cited by 32 publications

(41 citation statements)

References 17 publications

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“…Additionally, older patients and those with a higher education level were more likely to have completed these documents. This finding corresponds with prior studies that suggest that older patients and more educated patients are more likely to have completed advance directives (28, 29). It is important to take into account the way that patient characteristics impact a patient’s likelihood of creating advance care documents so that providers can target populations with lower rates of document completion.…”

Section: Discussionsupporting

confidence: 91%

Room for improvement: An examination of advance care planning documentation among gynecologic oncology patients

Brown

Shen

Urbauer

et al. 2016

Gynecologic Oncology

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Objectives The goals of this study were: (1) to evaluate patients’ knowledge regarding advance directives and completion rates of advance directives among gynecologic oncology patients and (2) to examine the association between death anxiety, disease symptom burden, and patient initiation of advance directives. Methods 110 gynecologic cancer patients were surveyed regarding their knowledge and completion of advance directives. Patients also completed the MD Anderson Symptom Inventory (MDASI) scale and Templer’s Death Anxiety Scale (DAS). Descriptive statistics were utilized to examine characteristics of the sample. Fisher’s exact tests and 2-sample t-tests were utilized to examine associations between key variables. Results Most patients were white (76.4%) and had ovarian (46.4%) or uterine cancer (34.6%). Nearly half (47.0%) had recurrent disease. The majority of patients had heard about advance directives (75%). Only 49% had completed a living will or medical power of attorney. Older patients and those with a higher level of education were more likely to have completed an advance directive (p<0.01). Higher MDASI Interference Score (higher symptom burden) was associated with patients being less likely to have a living will or medical power of attorney (p=0.003). Higher DAS score (increased death anxiety) was associated with patients being less likely to have completed a living will or medical power of attorney (p=0.03). Conclusion Most patients were familiar with advance directives, but less than half had created these documents. Young age, lower level of education, disease-related interference with daily activities, and a higher level of death anxiety were associated with decreased rates of advance directive completion, indicating these may be barriers to advance care planning documentation. Young patients, less educated patients, patients with increased disease symptom burden, and patients with increased death anxiety should be targeted for advance care planning discussions as they may be less likely to engage in advance care planning.

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Section: Discussionsupporting

confidence: 91%

Room for improvement: An examination of advance care planning documentation among gynecologic oncology patients

Brown

Shen

Urbauer

et al. 2016

Gynecologic Oncology

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“…[16][17][18] Upon NH admission, residents and/or families are notified of facility policy regarding advance directives (ADs); 19,20 however, we know little about conversations regarding EOL preferences. Conversations may be unlikely to occur when residents' physical or mental conditions are stable.…”

Section: Introductionmentioning

confidence: 99%

Conversations about End of Life: Perspectives of Nursing Home Residents, Family, and Staff

Towsley

Hirschman

Madden

2015

Journal of Palliative Medicine

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Background: Care in nursing homes (NHs) often overlooks individual values and preferences. Residents' voices are critical to discussions about preferences, yet there remains limited research on conversations about the end of life (EOL) from the perspective of older adults who reside in NHs. Objective: The aim of this study was to describe the communication, content and process, related to EOL conversations among residents, family, and staff. Methods: We used semistructured interviews in this qualitative, descriptive study to describe conversations about EOL preferences. We examined participants' conversation, when it occurred, and what was discussed. We queried about barriers to and facilitators in discussing EOL care in the NH setting. We interviewed residents (n = 16), family (n = 12), and interdisciplinary staff (n = 10) from four NHs. Results: The overarching theme-missed conversations-describes EOL-related communication. Residents, families, and staff rarely talked about EOL care preferences, nor did they pass along information about preferences or initiate conversations about EOL care with each other. Three categories explained missed conversations: inquiry (''No one asked''); assumptions (presence of an advance directive [AD], ''They know me''); and conveying (lack of conveying information or wishes). Existing barriers and lacking facilitators resulted in missed opportunities to hold conversations about EOL preferences. Conclusions: Not all residents wanted to have conversations, but many wanted to be asked about their preferences. Missed conversations may adversely affect the quality of EOL care. Conversations with residents can be initiated by asking residents who they would like involved in the conversation and drawing upon the experience of others.

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“…[13][14][15][16] However, existing studies pre-date the current ''graying'' of the HIV epidemic and are comprised of primarily patients younger than 50 years. [10][11][12]17 The aim of the present study was to examine current ACP completion rates and demographic and clinical features influencing documentation of ACP in a cohort of older HIV-infected persons who were receiving care in an HIV specialty clinic.…”

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confidence: 99%

HIV, Aging, and Advance Care Planning: Are We Successfully Planning for the Future?

Erlandson

Allshouse²,

Duong³

et al. 2012

Journal of Palliative Medicine

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Introduction: Studies of advance care planning (ACP) completion rates in HIV-infected persons pre-date the ''graying'' of the HIV epidemic. We sought to examine current ACP completion rates and factors influencing completion among HIV-infected persons. Methods: HIV-1-seropositive persons aged 45-65 years on effective antiretroviral therapy for a minimum of 6 months were enrolled in a cross-sectional survey. Likelihood of ACP was assessed by demographic and clinical characteristics, tested with odds ratios (OR) and 95% Wald confidence intervals (CI), and adjusted for gender. Results: Of 238 participants, 112 (47%) completed ACP. Persons ‡ 55 years of age (OR 2.8; CI 1.6,5.0; p < 0.001), males (OR 4.1; CI 1.8,9.3; p = 0.004), and persons with higher education (OR 2.2; CI 1.3,4.0; p = 0.007) were more likely to have completed ACP. Persons with a cardiac event were more likely to have completed ACP (OR 5.5; CI 1.6,25; p = 0.03), although this effect was diminished after adjusting for gender (OR 4.5; CI 0.95,21.4; p = 0.06). HIV infection diagnosed for greater than 5 years was not associated with ACP completion (OR 1.3; CI 0.7,2.7; p = 0.4). Current CD4+ cell counts were similar between those completing and not completing documentation (588 cells/lL and 604 cells/lL, respectively; p = 0.7). The likelihood of ACP did not significantly differ with other comorbidities. Discussion: Less than 50% of middle-aged patients in HIV care had documented ACP. In particular, women and those with lower education were at greatest risk of non-completion and may need interventions to improve ACP.

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What Factors Are Associated With Having an Advance Directive Among Older Adults Who Are New to Long Term Care Services?

Cited by 32 publications

References 17 publications

Room for improvement: An examination of advance care planning documentation among gynecologic oncology patients

Room for improvement: An examination of advance care planning documentation among gynecologic oncology patients

Conversations about End of Life: Perspectives of Nursing Home Residents, Family, and Staff

HIV, Aging, and Advance Care Planning: Are We Successfully Planning for the Future?

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