Abstract

Objectives

Advance care planning (ACP) typically comprises formal preparations (i.e., living will and/or durable power of attorney for health care) and informal discussions with family members and health care providers. However, some people complete formal documents without discussing them with others. If they become incapacitated, their appointed decision makers may lack guidance on how to interpret or enact their formal wishes. We document the prevalence and correlates of this partial approach to ACP.

Method

Using multinomial logistic regression models and data from a U.S. sample of 4,836 older adults in the 2018 wave of the National Health and Aging Trends Study (NHATS), this brief report evaluated associations between social integration indicators and the odds of completing (a) both discussions and formal plans (two-pronged ACP), (b) discussions only, (c) no ACP, and (d) formal ACP only (reference category). We adjust for demographic and health characteristics established as correlates of ACP.

Results

A minority (15%) of NHATS participants reported formal plans without having discussed them. Indicators of social isolation (e.g., smaller social networks and fewer social activities) increased the odds of engaging in formal planning only compared to two-pronged ACP. Socioeconomic disadvantage and probable dementia reduced the odds of having end-of-life conversations, whether as one’s only preparation or in tandem with formal preparations.

Discussion

Socially isolated persons are especially likely to do formal planning only, which is considered less effective than two-pronged ACP. Health care professionals should recognize that older adults with few kin may require additional support and guidance when doing ACP.

中文翻译：

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预先护理计划不足？没有进行个人对话的计划相关

摘要

目标

预先护理计划（ACP）通常包括正式的准备工作（即，生活意愿和/或持久的医疗保健授权书）以及与家庭成员和医疗服务提供者的非正式讨论。但是，有些人无需与他人讨论即可完成正式文档。如果他们丧失了工作能力，其任命的决策者可能会缺乏有关如何解释或执行其正式意愿的指导。我们记录了这种局部治疗ACP的普遍性和相关性。

方法

这份简短的报告使用多项Logistic回归模型和2018年美国国家卫生与老龄化趋势研究（NHATS）中来自美国4,836名老年人的样本数据，评估了社会融合指标与完成（a）两次讨论的几率之间的关联和正式计划（两方面的ACP），（b）仅讨论，（c）没有ACP，以及（d）仅正式ACP（参考类别）。我们根据建立的ACP相关指标调整人口和健康特征。

结果

少数（15％）的NHATS参与者报告了正式计划，而没有进行讨论。与两管齐下的ACP相比，社会孤立的指标（例如，较小的社交网络和较少的社交活动）增加了参与正式计划的几率。社会经济上的不利条件和可能的痴呆症减少了临终谈话的可能性，无论是作为一个人的唯一准备还是与正式准备相结合。

讨论区

与社会隔绝的人特别可能只进行正式计划，这被认为不如两管齐下的ACP有效。卫生保健专业人员应认识到，没有亲属的老年人在进行ACP时可能需要其他支持和指导。