Asking Older Adults With Impaired Cognition and Care Partners About Serious Illness Experiences Can Elicit Goals of Care During Advance Care Planning.
Glory H Thai, Valecia Hanna, Peiyuan Zhang and 4 others
PMID 40801875WHAT IT FOUND
Asking older adults with cognitive impairment about past experiences with serious illness helped 21.6% of participants articulate goals of care.
These memories clarified preferences for comfort or longevity, though those with severe dementia rarely contributed directly.
Key findings
01Only 21.6% of older adults and care partners related serious illness experiences to goals of care during advance care planning conversations.
02Older adults with mild to moderate cognitive impairment often participated in these discussions, whereas those with severe dementia rarely did.
03Care partners and patients described how witnessing severe disability or healthcare system failures shaped their preference for comfort-focused care.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study is qualitative and aims to generate hypotheses, not prove effectiveness. Participants with severe dementia rarely spoke, so the findings heavily reflect care partner perspectives. The sample was limited to English-speaking participants and was predominantly non-Hispanic White, restricting generalizability. Only a minority of participants (21.6%) made the connection between past experiences and goals of care.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume that asking about serious illness experiences will reliably elicit goals of care for all patients. Only about one in five participants made this connection, and those with severe dementia rarely contributed directly, meaning care partner views often dominated the conversation.