Factors Associated with Advance Care Planning Engagement Among Community-Dwelling Older Adults: A Cross-Sectional Study.

Cross-sectional design prevents causal conclusions; anxiety and decisional conflict may be consequences of poor engagement rather than causes. The sample was highly educated, had high health literacy, and had a lower prevalence of depression than the general older adult population, suggesting selection bias. The model explained only 24.3% of the variance in ACP engagement, indicating other unmeasured factors are important. Most participants completed the survey online, which may not represent those with lower digital literacy or functional impairment.

The authors declare no conflicts of interest. Funding was provided by the Australian Government National Health and Medical Research Council.

Do not assume that treating anxiety or depression will directly increase advance care planning engagement. The study shows an association, not causation, and depression was not linked to engagement in this sample. Furthermore, the participants were a highly educated and health-literate group, so these findings may not apply to patients with lower literacy or higher distress.