Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-23T20:54:46.936Z Has data issue: false hasContentIssue false
  • English
  • Français

Findings on Advance Care Plans among Cognitively Impaired Older Adults*

Published online by Cambridge University Press:  02 March 2015

Anna Jeznach ,
Holly Anna Tuokko ,
Mauricio A. Garcia-Barrera  and
Kelli Stajduhar
Anna Jeznach*
Affiliation:
Department of Psychology and Centre on Aging, University of Victoria
Holly Anna Tuokko
Affiliation:
Department of Psychology and Centre on Aging, University of Victoria
Mauricio A. Garcia-Barrera
Affiliation:
Department of Psychology and Centre on Aging, University of Victoria
Kelli Stajduhar
Affiliation:
School of Nursing and Centre on Aging, University of Victoria
*
†La correspondance et les demandes de tirés-à-part doivent être adressées à: / Correspondence and requests for offprints should be sent to: Anna Jeznach, M.Sc. Centre on Aging University of Victoria P.O. Box 1700 STN CSC Victoria, BC V8W 2Y2 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Cognitively impaired and cognitively intact older adults seemingly differ regarding engagement in aspects of advance care plans (ACPs). Through informant reports in the Canadian Study on Health and Aging, we examined differences between deceased cognitively impaired and intact older adults in components of ACPs: (1) discussions/arrangements for end-of-life care; (2) creation of legal documents; and in ACP outcomes, (3) location of death; and (4) dying in accordance with wishes. Cognitively impaired older adults were more likely to have made arrangements for a substitute decision-maker (OR = 1.90) and to have created legal documents (OR = 2.64 for health care preferences, OR = 2.00 for naming a decision-maker). They were less likely to have discussed preferences for end-of-life care (OR = 0.62). These findings suggest that ACPs differ for cognitively impaired persons, indicating a need for further investigation. This is a step towards understanding this complex process in a particularly vulnerable population.

Résumé

Les personnes âgées qui ont une déficience cognitive et celles qui sont intactes cognitivement diffèrent apparemment par rapport à leur participation dans aspects de la planification préalable des soins (PPS). Utilisant les rapports d'informateurs dans l'Étude canadienne sur la santé et le vieillissement, nous avons examiné les différences entre les adultes décédés avec des troubles cognitives et les personnes âgées intactes dans les processus PPS en ce qui concerne: (1) des discussions ou dispositions pour les soins à la fin de vie; (2) la création de documents juridiques, et les résultats de PPS; (3) le lieu du décès; et (4) une mort qui conforme aux souhaits. Les personnes âgées qui ont été atteints de déficience cognitive étaient plus susceptibles d'avoir pris des arrangements pour un mandataire (RC = 1,90), et ont créé des documents juridiques (RC = 2,64 pour les préférences de soins de santé, RC = 2,00 pour nommer un décideur). Elles étaient moins susceptibles d'avoir discutées leurs préférences vis-à-vis les soins de fin de vie (OR = 0,62). Ces résultats suggèrent que PPS diffèrent chez les personnes souffrant de troubles cognitifs, indiquant un besoin pour une enquête plus approfondie. Ceci est une étape vers la compréhension de ce processus complexe dans un population particulièrement vulnérable.

Keywords

agingadvance care planscognitive impairmentend of lifevieillissmentplanification préalable des soinsdeficience cognitive (trouble cognitif)soins de fin de vie
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 34 , Issue 2 , June 2015 , pp. 165 - 175
Copyright
Copyright © Canadian Association on Gerontology 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

The Canadian Study of Health and Aging (CSHA) study was initially funded by the Seniors’ Independence Research Program, through Health Canada’s National Health Research and Development Program (NHRDP project #6606-3954-MC(S)); supplementary funding for analysis of the caregiver component was provided by the Medical Research Council.

References

Alano, G. J., Pekmezaris, R., Tai, J. Y., Hussain, M. J., Jeune, J., Louis, B., et al. (2010). Factors influencing older adults to complete advance directives. Palliative and Supportive Care, 8(3), 267–275.Google Scholar
Alzheimer Europe. (2006). Alzheimer Europe report: The use of advance directives by people with dementia. Luxembourg: Author.Google Scholar
Ayalon, L., Bachner, Y. G., Dwolatzky, T., & Heinik, J. (2012). Preferences for end-of-life treatment: Concordance between older adults with dementia or mild cognitive impairment and their spouses. International Psychogeriatrics, 24(11), 1798–1804.Google Scholar
Baron, R., & Kenny, D. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182.CrossRefGoogle ScholarPubMed
Black, B. S., Fogarty, L. A., Phillips, H., Finucane, T., Loreck, D. J., Baker, , et al. (2009). Surrogate decision makers’ understanding of dementia patients’ prior wishes for end-of-life care. Journal of Aging and Health, 21(4), 627–650. doi:10.1177/0898264309333316.Google Scholar
Bomba, P. A. (2005). Advance care planning along the continuum. Case Manager, 16(2), 68–72.Google Scholar
Casarett, D. J., Teno, J., & Higginson, I. (2006). How should nations measure the quality of end-of-life care for older adults? Recommendations for an international minimum data set. Journal of the American Geriatrics Society, 54(11), 1765–1771.Google Scholar
Dening, K. H., Jones, L., & Sampson, E. L. (2011). Advance care planning for people with dementia: A review. International Psychogeriatrics, 23(10), 1535–1551.Google Scholar
DiCarlo, A., Baldereschi, M., Amaducci, L., Maggi, S., Grigoletto, F., Scarlato, , et al. (2000). Cognitive impairment without dementia in older people: Prevalence, vascular risk factors, impact on disability. The Italian longitudinal study of aging. Journal of the American Geriatrics Society, 48(7), 775–782.CrossRefGoogle Scholar
Dobalian, A. (2006). Advance care planning documents in nursing facilities: Results from a nationally representative survey. Archives of Gerontology & Geriatrics, 43(2), 193–212.Google Scholar
Engel, S. E., Kiely, D. K., & Mitchell, S. L. (2006). Satisfaction with end-of-life care for nursing home residents with advanced dementia. Journal of the American Geriatrics Society, 54(10), 1567–1572.CrossRefGoogle ScholarPubMed
Garand, L., Dew, M. A., Lingler, J. H., & DeKosky, S. T. (2011). Incidence and predictors of advance care planning among persons with cognitive impairment. The American Journal of Geriatric Psychiatry, 19(8), 712–720.Google Scholar
Garrett, D. D., Tuokko, H., Stajduhar, K. I., Lindsay, J., & Buehler, S. (2008). Planning for end-of-life care: Findings from the Canadian Study of Health and Aging. Canadian Journal on Aging, 27(1), 11–21.Google Scholar
Gavrilla, D., Antunez, C., Tormo, M. J., Carles, R., Garcia Santos, J. M., Parrilla, G., et al. (2009). Prevalence of dementia and cognitive impairment in southeastern Spain: The Ariadna study. Acta Neurologica Scandinavica, 120(5), 300–307.CrossRefGoogle Scholar
Givens, J. L., Lopez, R. P., Mazor, K. M., & Mitchell, S. L. (2012). Sources of stress for family members of nursing home residents with advanced dementia. Alzheimer Disease and Associated Disorders, 26(3), 254–259.Google Scholar
Graham, J. E., Rockwood, K., Beattie, B. L., Eastwood, R., Gauthier, S., Tuokko, H., et al. (1997). Prevalence and severity of cognitive impairment with and without dementia in an elderly population. The Lancet, 349(9068), 1793–1796.Google Scholar
Haydar, Z. R., Lowe, A. J., Kahveci, K. L., Weatherford, W., & Finucane, T. (2004). Differences in end-of-life preferences between congestive heart failure and dementia in a medical house calls program. Journal of the American Geriatrics Society, 52(5), 736–740.Google Scholar
Hilal, S., Ikram, M. K., Tan, C. S., Catindig, J. A., Dong, Y. H., Lim, L. B., et al. (2013). Prevalence of cognitive impairment in Chinese: Epidemiology of dementia in Singapore study. Journal of Neurology, Neurosurgery, and Psychiatry, 84(6), 686–692.Google Scholar
Hirschman, K. B., Kapo, J. M., & Karlawish, J. H. T. (2006). Why doesn’t a family member of a person with advanced dementia use a substituted judgment when making a decision for that person? American Journal of Geriatric Psychiatry, 14(8), 659–667.Google Scholar
Hirschman, K. B., Kapo, J. M., & Karlawish, J. H. T. (2008). Identifying the factors that facilitate or hinder advance planning by persons with dementia. Alzheimer Disease and Associated Disorders, 22(3), 293–298.Google Scholar
Houttekier, D., Cohen, J., Bilsen, J., Addington-Hall, J., Onwuteaka-Philipsen, B. D., & Deliens, L. (2010). Place of death of older persons with dementia: A study in five European countries. Journal of the American Geriatric Society, 58(4), 751–756.Google Scholar
Karel, M. J., Moye, J., Bank, A., & Azar, A. R. (2007). Three methods of assessing values for advance care planning: Comparing persons with and without dementia. Journal of Aging and Health, 19(1), 123–151.CrossRefGoogle ScholarPubMed
Levi, B. H., Dellasega, C., Whitehead, M., & Green, M. J. (2010). What influences individuals to engage in advance care planning? American Journal of Hospice and Palliative Care, 27, 306–312.CrossRefGoogle ScholarPubMed
Lingler, J. H., Hirschman, K. B., Garand, L., Dew, M. A., Becker, J. T., Schulz, R., et al. (2008). Frequency and correlates of advance planning among cognitively impaired older adults. American Journal of Geriatric Psychiatry, 16(8), 643–649.CrossRefGoogle ScholarPubMed
McAuley, W. J., & Travis, S. S. (2003). Advance care planning among residents in long-term care. American Journal of Hospice and Palliative Medicine, 20(5), 353–359.CrossRefGoogle ScholarPubMed
McCarthy, M., Addington-Hall, J., & Altmann, D. (1997). The experience of dying with dementia: A retrospective study. International Journal of Geriatric Psychiatry, 12(3), 404–409.Google Scholar
McDowell, I., Xi, G., Lindsay, J., & Tuokko, H. (2004). Canadian Study of Health and Aging: Study description and patterns of early cognitive decline. Aging, Neuropsychology, and Cognition, 11(2–3), 149–168.Google Scholar
Pinzon, L. C. E., Claus, M., Perrar, K. M., Zepf, K. I., Letzel, S., & Weber, M. (2013). Dying with dementia: Symptom burden, quality of care, and place of death. Deutsches Ärzteblatt International, 110(12), 195–202.Google Scholar
Robinson, L., Dickinson, C., Bamford, C., Clark, A., Hughes, J., & Exley, C. (2012a). A qualitative study: Professionals’ experiences of advance care planning in dementia and palliative care, ‘a good idea in theory but …’. Palliative Medicine, 27(5), 401–408.CrossRefGoogle Scholar
Robinson, L., Dickinson, C., Rousseau, N., Beyer, F., Clark, A., Hughes, J., et al. (2012b). A systematic review of the effectiveness of advance care planning interventions for people with cognitive impairment and dementia. Age and Aging, 41(2), 263–269.Google Scholar
Rurup, M. L., Onwuteaka-Philipsen, B. D., Pasman, H. R. W., Ribbe, M. W., & van der Wal, G. (2006). Attitudes of physicians, nurses and relatives towards end-of-life decisions concerning nursing home patients with dementia. Patient Education and Counseling, 61(3), 372–380.Google Scholar
Sampson, E. L., Jones, L., Thune-Boyle, I. C. V., Kukkastenvehmas, R., King, M., Leurent, B., et al. (2011). Palliative assessment and advance care planning in severe dementia: An exploratory randomized controlled trial of a complex intervention. Palliative Medicine, 25(3), 197–209.Google Scholar
Shalowitz, D. I., Garrett-Mayer, E., & Wendler, D. (2006). The accuracy of surrogate decision makers: A systematic review. Archives of Internal Medicine, 166, 493–497.Google Scholar
SPSS Inc. (2009). PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc.Google Scholar
Stajduhar, K. I., Allan, D. E., Cohen, S. R., & Keyland, D. K. (2008). Preferences for location of death of seriously ill hospitalized patients: Perspectives from Canadian patients and their family caregivers. Palliative Medicine, 22, 85–88.Google Scholar
Statistics Canada. (2010). Population projections for Canada, provinces and territories, 2009 to 2036. (No. 91-250-X). Ottawa, ON: Author.Google Scholar
Teno, J. M., Nelson, H. L., & Lynn, J. (1994). Advance care planning priorities for ethical and empirical research. The Hastings Center Report, 24(6), S32–S36.Google Scholar
Triplett, P., Black, B. S., Phillips, H., Fahrendorf, S. R., Schwartz, J., Angelino, A. F., et al. (2008). Content of advance directives for individuals with advanced dementia. Journal of Aging and Health, 20(5), 583–596.Google Scholar
Vandervoort, A., van den Block, L., van der Steen, J., Stichele, R. V., Bilsen, J., & Deliens, L. (2012). Advance directives and physicians’ orders in nursing home residents with dementia in Flanders, Belgium: Prevalence and associated outcomes. International Psychogeriatrics, 24(7), 1133–1143.Google Scholar