Insufficient Advance Care Planning? Correlates of Planning Without Personal Conversations
Insufficient Advance Care Planning? Correlates of Planning Without Personal Conversations
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DOI：
10.1093/geronb/gbaa076
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发表时间：
2021-01-01
影响因子：
6.2
通讯作者：
Ornstein, Katherine A.
中科院分区：
文献类型：
--
作者：
Boerner, Kathrin;Moorman, Sara M.;Ornstein, Katherine A.
目标：预先护理计划 (ACP) 通常包括正式准备（即生前遗嘱和/或持久的医疗保健授权书）以及与家庭成员和医疗保健提供者的非正式讨论。然而，有些人在不与他人讨论的情况下就完成了正式文件。如果他们丧失行为能力，他们指定的决策者可能缺乏如何解释或实现他们的正式愿望的指导。我们记录了这种部分 ACP 方法的普遍性和相关性。方法：使用多项逻辑回归模型和 2018 年国家健康与老龄化趋势研究 (NHATS) 浪潮中 4,836 名美国老年人样本的数据，这份简短的报告评估了社会融合指标与完成 (a) 讨论和正式计划（双管齐下 ACP）、(b) 仅讨论、(c) 的几率之间的关联。 无 ACP，以及 (d) 仅正式 ACP（参考类别）。我们根据与 ACP 相关的人口和健康特征进行调整。结果：少数 (15%) 的 NHATS 参与者报告了正式计划，但没有进行讨论。与双管齐下的 ACP 相比，社会孤立指标（例如较小的社交网络和较少的社交活动）仅增加了参与正式规划的可能性。社会经济劣势和可能的痴呆症降低了进行临终谈话的可能性，无论是作为一个人唯一的准备还是与正式准备同时进行。讨论：社会孤立的人特别有可能只进行正式的计划，这被认为不如双管齐下的 ACP 有效。医疗保健专业人员应认识到，亲属较少的老年人在进行 ACP 时可能需要额外的支持和指导。
Objectives: Advance care planning (ACP) typically comprises formal preparations (i.e., living will and/or durable power of attorney for health care) and informal discussions with family members and health care providers. However, some people complete formal documents without discussing them with others. If they become incapacitated, their appointed decision makers may lack guidance on how to interpret or enact their formal wishes. We document the prevalence and correlates of this partial approach to ACP.Method: Using multinomial logistic regression models and data from a U.S. sample of 4,836 older adults in the 2018 wave of the National Health and Aging Trends Study (NHATS), this brief report evaluated associations between social integration indicators and the odds of completing (a) both discussions and formal plans (two-pronged ACP), (b) discussions only, (c) no ACP, and (d) formal ACP only (reference category). We adjust for demographic and health characteristics established as correlates of ACP.Results: A minority (15%) of NHATS participants reported formal plans without having discussed them. Indicators of social isolation (e.g., smaller social networks and fewer social activities) increased the odds of engaging in formal planning only compared to two-pronged ACP. Socioeconomic disadvantage and probable dementia reduced the odds of having end-of-life conversations, whether as one's only preparation or in tandem with formal preparations.Discussion: Socially isolated persons are especially likely to do formal planning only, which is considered less effective than two-pronged ACP. Health care professionals should recognize that older adults with few kin may require additional support and guidance when doing ACP.