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Unmarried patients with early cognitive impairment are more likely than their married counterparts to complete advance care plans

Published online by Cambridge University Press:  23 November 2016

Tong Jen Lo ,
Ngoc Huong Lien Ha ,
Chong Jin Ng ,
Gabriel Tan ,
Hui Mien Koh  and
Philip Lin Kiat Yap
Tong Jen Lo
Affiliation:
Geriatric Centre, Khoo Teck Puat Hospital, Alexandra Health System, 90 Yishun Central, Singapore, 768828, Singapore National Cancer Centre, 11 Hospital Drive, Singapore, 169610, Singapore
Ngoc Huong Lien Ha
Affiliation:
Geriatric Centre, Khoo Teck Puat Hospital, Alexandra Health System, 90 Yishun Central, Singapore, 768828, Singapore Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
Chong Jin Ng
Affiliation:
Geriatric Centre, Khoo Teck Puat Hospital, Alexandra Health System, 90 Yishun Central, Singapore, 768828, Singapore
Gabriel Tan
Affiliation:
Ministry of Health Holdings, 1 Maritime Square, Singapore, 099253, Singapore
Hui Mien Koh
Affiliation:
Geriatric Centre, Khoo Teck Puat Hospital, Alexandra Health System, 90 Yishun Central, Singapore, 768828, Singapore
Philip Lin Kiat Yap*
Affiliation:
Geriatric Centre, Khoo Teck Puat Hospital, Alexandra Health System, 90 Yishun Central, Singapore, 768828, Singapore Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
*
Correspondence should be addressed to: A/Prof Yap Lin Kiat Philip, Senior Consultant Geriatrician, Department of Geriatric Medicine, 90 Yishun Central, Khoo Teck Puat Hospital, Alexandra Health System, Singapore 768828. Phone: 65-66022154. Email: [email protected].
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Abstract

Background:

Patients with early cognitive impairment (ECI) face the prospect of progressive cognitive decline that impairs their ability to make decisions on financial and personal matters. Advance care planning (ACP) is a process that facilitates decision making on future care and often includes identifying a proxy decision maker. This prospective study explores factors related to completion or non-completion of ACP in patients with ECI.

Methods:

Patients with ECI (n = 158, Mage = 76.2 ± 7.25 years) at a memory clinic received psycho-education and counseling on the importance of ACP and followed-up longitudinally for up to 12 months to ascertain if ACP had been completed. Univariate and logistic regression were used to analyze factors related to completion and non-completion of ACP.

Results:

Seventy-seven patients (48.7%) were initially willing to consider ACP after the counseling and psycho-educational session but only 17 (11.0%) eventually completed ACP. On logistic regression, patients who were single were 8.9 times more likely to complete ACP than those who were married (p = 0.007). Among those initially willing to consider ACP, factors impeding completion of ACP included patient (48.0%), process (31.0%), and family factors (21.0%).

Conclusions:

As unmarried patients may not have immediate family members to depend on to make decisions, they may perceive ACP to be more important and relevant. Understanding the barriers to ACP completion can facilitate targeted interventions to improve the uptake of ACP.

Keywords

advance care planninglasting power of attorneyearly cognitive impairmentcompletionnon-completionperson-centered care
Type
Research Article
Information
International Psychogeriatrics , Volume 29 , Issue 3 , March 2017 , pp. 509 - 516
Copyright
Copyright © International Psychogeriatric Association 2016 

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