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Findings on Advance Care Plans among Cognitively Impaired Older Adults*

Published online by Cambridge University Press:  02 March 2015

Anna Jeznach ,
Holly Anna Tuokko ,
Mauricio A. Garcia-Barrera  and
Kelli Stajduhar
Anna Jeznach*
Affiliation:
Department of Psychology and Centre on Aging, University of Victoria
Holly Anna Tuokko
Affiliation:
Department of Psychology and Centre on Aging, University of Victoria
Mauricio A. Garcia-Barrera
Affiliation:
Department of Psychology and Centre on Aging, University of Victoria
Kelli Stajduhar
Affiliation:
School of Nursing and Centre on Aging, University of Victoria
*
†La correspondance et les demandes de tirés-à-part doivent être adressées à: / Correspondence and requests for offprints should be sent to: Anna Jeznach, M.Sc. Centre on Aging University of Victoria P.O. Box 1700 STN CSC Victoria, BC V8W 2Y2 (abraslav@uvic.ca)
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Abstract

Cognitively impaired and cognitively intact older adults seemingly differ regarding engagement in aspects of advance care plans (ACPs). Through informant reports in the Canadian Study on Health and Aging, we examined differences between deceased cognitively impaired and intact older adults in components of ACPs: (1) discussions/arrangements for end-of-life care; (2) creation of legal documents; and in ACP outcomes, (3) location of death; and (4) dying in accordance with wishes. Cognitively impaired older adults were more likely to have made arrangements for a substitute decision-maker (OR = 1.90) and to have created legal documents (OR = 2.64 for health care preferences, OR = 2.00 for naming a decision-maker). They were less likely to have discussed preferences for end-of-life care (OR = 0.62). These findings suggest that ACPs differ for cognitively impaired persons, indicating a need for further investigation. This is a step towards understanding this complex process in a particularly vulnerable population.

Résumé

Les personnes âgées qui ont une déficience cognitive et celles qui sont intactes cognitivement diffèrent apparemment par rapport à leur participation dans aspects de la planification préalable des soins (PPS). Utilisant les rapports d'informateurs dans l'Étude canadienne sur la santé et le vieillissement, nous avons examiné les différences entre les adultes décédés avec des troubles cognitives et les personnes âgées intactes dans les processus PPS en ce qui concerne: (1) des discussions ou dispositions pour les soins à la fin de vie; (2) la création de documents juridiques, et les résultats de PPS; (3) le lieu du décès; et (4) une mort qui conforme aux souhaits. Les personnes âgées qui ont été atteints de déficience cognitive étaient plus susceptibles d'avoir pris des arrangements pour un mandataire (RC = 1,90), et ont créé des documents juridiques (RC = 2,64 pour les préférences de soins de santé, RC = 2,00 pour nommer un décideur). Elles étaient moins susceptibles d'avoir discutées leurs préférences vis-à-vis les soins de fin de vie (OR = 0,62). Ces résultats suggèrent que PPS diffèrent chez les personnes souffrant de troubles cognitifs, indiquant un besoin pour une enquête plus approfondie. Ceci est une étape vers la compréhension de ce processus complexe dans un population particulièrement vulnérable.

Keywords

agingadvance care planscognitive impairmentend of lifevieillissmentplanification préalable des soinsdeficience cognitive (trouble cognitif)soins de fin de vie
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 34 , Issue 2 , June 2015 , pp. 165 - 175
Copyright
Copyright © Canadian Association on Gerontology 2015 

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Footnotes

*

The Canadian Study of Health and Aging (CSHA) study was initially funded by the Seniors’ Independence Research Program, through Health Canada’s National Health Research and Development Program (NHRDP project #6606-3954-MC(S)); supplementary funding for analysis of the caregiver component was provided by the Medical Research Council.

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