Advance Care Planning Among Older Adults with Cognitive Impairment.
Zahra Rahemi, Ayse Malatyali, Swann A Adams and 5 others
PMID 36541134WHAT IT FOUND
Older adults with dementia were less likely to have a living will than those with normal cognition.
Black and Hispanic participants were less likely to have either planning document across cognitive groups.
Key findings
01Living will ownership decreased as cognition worsened: 54.1% of people with normal cognition, 47.0% with cognitive impairment, and 43.3% with dementia had one.
02Black and Hispanic participants were less likely than white participants to have a living will and a durable power of attorney in all three cognition groups.
03In the dementia group, each one-point increase in loneliness score was associated with being 84% more likely to have a living will and about 2.5 times more likely to have a durable power of attorney.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The analysis used only living wills and durable powers of attorney, so it did not capture informal advance care planning conversations or goals-of-care discussions. Because it was a cross-sectional survey analysis, it describes associations rather than showing what caused advance care planning. African Americans, Hispanic adults, and Florida residents were overrepresented in the survey data. The researchers used survey weights for descriptive statistics but not for the model analyses. Income and healthcare expenditure were not included, so other financial or access factors may explain some associations. The study measured cognitive status with a survey score, not a clinical dementia diagnosis.
Declared interests
The underlying Health and Retirement Study was funded by the National Institute on Aging and the Social Security Administration. The authors declared no potential conflicts of interest.
The easy way to misread this
Do not conclude that loneliness causes older adults with dementia to make advance care plans. The study only found that higher loneliness scores were associated with having a living will or durable power of attorney in the dementia group.