Advance care directive prevalence among older Australians and associations with person‐level predictors and quality indicators
Abstract Background Advance care planning (ACP) conversations may result in preferences for medical care being documented. Objective To explore the uptake and quality of advance care directives (ACDs) among older Australians accessing health and aged care services, by overall ACP documentation preva...
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doaj-712e329a7b90412389446ef069db1b412021-08-17T05:09:01ZengWileyHealth Expectations1369-65131369-76252021-08-012441312132510.1111/hex.13264Advance care directive prevalence among older Australians and associations with person‐level predictors and quality indicatorsKimberly Buck0Linda Nolte1Marcus Sellars2Craig Sinclair3Ben P. White4Helana Kelly5Ashley Macleod6Karen M. Detering7Advance Care Planning Australia Austin Health Heidelberg Vic AustraliaAdvance Care Planning Australia Austin Health Heidelberg Vic AustraliaAdvance Care Planning Australia Austin Health Heidelberg Vic AustraliaAustralian Research Council Centre of Excellence in Population Ageing Research University of New South Wales Sydney NSW AustraliaAustralian Centre for Health Research Law Faculty of Law Queensland University of Technology Brisbane Qld AustraliaAdvance Care Planning Australia Austin Health Heidelberg Vic AustraliaAdvance Care Planning Australia Austin Health Heidelberg Vic AustraliaAdvance Care Planning Australia Austin Health Heidelberg Vic AustraliaAbstract Background Advance care planning (ACP) conversations may result in preferences for medical care being documented. Objective To explore the uptake and quality of advance care directives (ACDs) among older Australians accessing health and aged care services, by overall ACP documentation prevalence, person‐level predictors and ACD quality indicators. Design and Setting National multi‐centre health record audit in general practices (GP), hospitals and residential aged care facilities (RACF). Participants A total of 4187 people aged ≥65 years attending their GP (n = 676), admitted to hospital (n = 1122) or residing in a RACF (n = 2389). Main Outcome Measures ACP documentation prevalence by setting and type including person‐completed ACDs and non‐ACD documents (completed by a health professional or someone else); person‐level predictors and quality indicators of ACDs. Results Overall ACP documentation prevalence was 46.5% (29.2% weighted). ACD prevalence was 25.3% (14.2% weighted). Unweighted ACD prevalence was higher in RACFs (37.7%) than in hospitals (11.1%) and GPs (5.5%). 35.8% of ACP documentation was completed by a health professional (9.7% weighted), and 18.1% was completed by someone else (10.6% weighted). Having an ACD was positively associated with being female, older, having two or more medical conditions, receiving palliative care, being divorced/separated and being in a RACF. Only 73% of ACDs included full name, signature, document date and witnessing. Conclusions and Contribution Low ACP documentation prevalence and a lack of accessible, person‐completed and quality ACDs represent an important ACP implementation issue. Low prevalence is complicated by poor document quality and a higher prevalence of documents being completed by someone other than the person.https://doi.org/10.1111/hex.13264advance care directiveadvance care planningaged care servicegeneral practicehealth serviceprevalence |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kimberly Buck Linda Nolte Marcus Sellars Craig Sinclair Ben P. White Helana Kelly Ashley Macleod Karen M. Detering |
spellingShingle |
Kimberly Buck Linda Nolte Marcus Sellars Craig Sinclair Ben P. White Helana Kelly Ashley Macleod Karen M. Detering Advance care directive prevalence among older Australians and associations with person‐level predictors and quality indicators Health Expectations advance care directive advance care planning aged care service general practice health service prevalence |
author_facet |
Kimberly Buck Linda Nolte Marcus Sellars Craig Sinclair Ben P. White Helana Kelly Ashley Macleod Karen M. Detering |
author_sort |
Kimberly Buck |
title |
Advance care directive prevalence among older Australians and associations with person‐level predictors and quality indicators |
title_short |
Advance care directive prevalence among older Australians and associations with person‐level predictors and quality indicators |
title_full |
Advance care directive prevalence among older Australians and associations with person‐level predictors and quality indicators |
title_fullStr |
Advance care directive prevalence among older Australians and associations with person‐level predictors and quality indicators |
title_full_unstemmed |
Advance care directive prevalence among older Australians and associations with person‐level predictors and quality indicators |
title_sort |
advance care directive prevalence among older australians and associations with person‐level predictors and quality indicators |
publisher |
Wiley |
series |
Health Expectations |
issn |
1369-6513 1369-7625 |
publishDate |
2021-08-01 |
description |
Abstract Background Advance care planning (ACP) conversations may result in preferences for medical care being documented. Objective To explore the uptake and quality of advance care directives (ACDs) among older Australians accessing health and aged care services, by overall ACP documentation prevalence, person‐level predictors and ACD quality indicators. Design and Setting National multi‐centre health record audit in general practices (GP), hospitals and residential aged care facilities (RACF). Participants A total of 4187 people aged ≥65 years attending their GP (n = 676), admitted to hospital (n = 1122) or residing in a RACF (n = 2389). Main Outcome Measures ACP documentation prevalence by setting and type including person‐completed ACDs and non‐ACD documents (completed by a health professional or someone else); person‐level predictors and quality indicators of ACDs. Results Overall ACP documentation prevalence was 46.5% (29.2% weighted). ACD prevalence was 25.3% (14.2% weighted). Unweighted ACD prevalence was higher in RACFs (37.7%) than in hospitals (11.1%) and GPs (5.5%). 35.8% of ACP documentation was completed by a health professional (9.7% weighted), and 18.1% was completed by someone else (10.6% weighted). Having an ACD was positively associated with being female, older, having two or more medical conditions, receiving palliative care, being divorced/separated and being in a RACF. Only 73% of ACDs included full name, signature, document date and witnessing. Conclusions and Contribution Low ACP documentation prevalence and a lack of accessible, person‐completed and quality ACDs represent an important ACP implementation issue. Low prevalence is complicated by poor document quality and a higher prevalence of documents being completed by someone other than the person. |
topic |
advance care directive advance care planning aged care service general practice health service prevalence |
url |
https://doi.org/10.1111/hex.13264 |
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