Department of Gerontology, University of Massachusetts Boston, Massachusetts.
Department of Sociology, Boston College, Chestnut Hill, Massachusetts.
J Gerontol B Psychol Sci Soc Sci. 2021 Jan 1;76(1):104-108. doi: 10.1093/geronb/gbaa076.
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.
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.
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.
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.
预先医疗照护计划（ACP）通常包括正式准备（即生前预嘱和/或医疗保健持久授权书）和与家庭成员及医疗保健提供者进行的非正式讨论。然而，有些人在没有与他人讨论的情况下完成了正式文件。如果他们丧失了能力，他们指定的决策者可能缺乏如何解释或执行其正式意愿的指导。我们记录了这种部分 ACP 方法的流行程度和相关因素。
使用多项逻辑回归模型和来自美国国家健康老龄化趋势研究（NHATS）的 2018 年 4836 名老年人样本的数据，本简要报告评估了社会融合指标与完成以下各项之间的关联：（a）讨论和正式计划（双重 ACP），（b）仅讨论，（c）无 ACP，以及（d）仅正式 ACP（参考类别）。我们调整了人口统计学和健康特征，这些特征被确定为 ACP 的相关因素。
少数（15%）NHATS 参与者报告了没有讨论过的正式计划。社会隔离的指标（例如，较小的社交网络和较少的社交活动）增加了仅进行正式规划而不是双重 ACP 的可能性。社会经济劣势和可能的痴呆症降低了进行临终对话的可能性，无论是作为唯一的准备还是与正式准备同时进行。
社会孤立的人特别可能只进行正式规划，这被认为不如双重 ACP 有效。医疗保健专业人员应该认识到，与亲人较少的老年人在进行 ACP 时可能需要额外的支持和指导。
