Abshire Saylor Martha, Hanna Valecia, Zhang Peiyuan, Thai Glory Huynh, Green Chase Mulholland, Cagle John G, Wolff Jennifer L
Johns Hopkins School of Nursing, Baltimore, Maryland, USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Alzheimers Dement. 2025 Jan;21(1):e14331. doi: 10.1002/alz.14331. Epub 2024 Dec 10.
Recommendations for advance care planning (ACP) in persons with cognitive impairment are based on expert input without insight from actual ACP conversations.
We used thematic analysis to analyze transcripts of ACP conversations for 88 older adults with normal cognition (n = 15), mild cognitive impairment (n = 13), and scores consistent with dementia (n = 60).
Patients with dementia were least verbally active; however, some shared values and identified surrogates. We identified three themes: (1) cognitive impairment inhibits participation in ACP, but individuals with dementia are able to contribute; (2) care partners have a key role in supporting ACP across the spectrum of cognitive impairment; and (3) structured questions about values and tailored communication strategies can facilitate engagement of older adults with dementia.
Our findings reinforce best practice recommendations for early ACP and identify strategies to increase patient engagement among older adults with cognitive impairment with support of care partners.
Data from actual ACP conversations involving older adults with a range of cognitive function and their care partners reinforce best practice recommendations and suggest practical implications for education and training. Family involvement in ACP was valued by older adults and improved engagement. ACP initiatives should prioritize eliciting values of older adults with dementia and improving skills for communication to increase engagement.
针对认知障碍患者的预先护理计划（ACP）建议是基于专家意见，而非来自实际的 ACP 对话。
我们采用主题分析法，分析了 88 名认知正常的老年人（n = 15）、轻度认知障碍患者（n = 13）以及符合痴呆症评分标准的患者（n = 60）的 ACP 对话记录。
痴呆症患者在言语上最不活跃；然而，一些患者分享了价值观并指定了代理人。我们确定了三个主题：（1）认知障碍会抑制参与 ACP，但痴呆症患者能够做出贡献；（2）护理伙伴在支持认知障碍各阶段的 ACP 方面发挥关键作用；（3）关于价值观的结构化问题和量身定制的沟通策略可以促进痴呆症老年人的参与。
我们的研究结果强化了早期 ACP 的最佳实践建议，并确定了在护理伙伴支持下提高认知障碍老年人患者参与度的策略。
来自涉及具有不同认知功能的老年人及其护理伙伴的实际 ACP 对话的数据强化了最佳实践建议，并对教育和培训提出了实际意义。老年人重视家庭参与 ACP，并提高了参与度。ACP 倡议应优先引出痴呆症老年人的价值观，并提高沟通技巧以增加参与度。
