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. 2023 Nov;40(11):1182-1189.
doi: 10.1177/10499091221146255. Epub 2022 Dec 21.

Advance Care Planning Among Older Adults with Cognitive Impairment

Zahra Rahemi  1 , Ayse Malatyali  2 , Swann A Adams  3 , Olga F Jarrín  4 , George Demiris  5 , Veronica Parker  1 , Reza Ghaiumy Anaraky  6 , Cheryl J Dye  7
Affiliations

Advance Care Planning Among Older Adults with Cognitive Impairment

Zahra Rahemi et al. Am J Hosp Palliat Care. 2023 Nov.

Abstract

In this study, we used data from the Health and Retirement Study (HRS) to investigate factors associated with older adults' engagement with advance care planning (ACP) across varying levels of cognitive functioning status. Our analysis used a sample of 17,698 participants in the HRS 2014 survey. Survey descriptive procedures (Proc SurveyMeans, Proc SurveyFreq) and logistic regression procedures (Proc SurveyLogistic) were used. Race, ethnicity, level of cognition, education, age, and number of chronic diseases consistently predicted ACP. Participants with lower levels of cognition were less likely to have a living will and durable power of attorney for healthcare (DPOAH). African American and Hispanic participants, younger participants, and those with lower cognition and education levels were less likely to engage in ACP. Marital status and loneliness predicted ACP engagement. Some results varied across the cognition cohorts. Our results indicated that sociodemographic status, together with health and cognitive status, has a significant role in predicting ACP. The results can provide valuable insights on ACP for older adults with or at risk of Alzheimer's disease and related dementia and other cognitive impairments, caregivers, families, and healthcare providers.

Keywords: Alzheimer’s disease and related dementia; advance care planning; durable power of attorney for healthcare; end-of-life care; health and retirement study; living will; older adults; sociodemographic status.

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Conflict of interest statement

Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

    1. Alzheimer’s Association Report. 2021 Alzheimer’s disease facts and figures. Alzheimer’s Dement. 2021;17(3):327–406. doi:10.1002/alz.12328 - DOI - PubMed
    1. National Institute of Neurological Disorders Stroke NI of H. Focus on Alzheimer’s Disease and Related Dementias; 2022. https://www.ninds.nih.gov/Current-Research/Focus-Disorders/Alzheimers-Re.... Accessed April 21, 2022.
    1. Nelson P, Brayne C, Flanagan M, et al. Frequency of LATE neuropathologic change across the spectrum of Alzheimer’s disease neuropathology: combined data from 13 community-based or population-based autopsy cohorts. Acta Neuropathol. 2022. Published online. doi:10.1007/s00401-022-02444-1 - DOI - PMC - PubMed
    1. Matthews KA, Xu W, Gaglioti AH, et al. Racial and ethnic estimates of Alzheimer ’ s disease and related dementias in the United States (2015–2060) in adults aged 65 years. Alzheimer’s Dement. 2019;15(1):17–24. doi:10.1016/j.jalz.2018.06.3063 - DOI - PMC - PubMed
    1. Amjad H, Roth DL, Sheehan OC, Lyketsos CG, Wolff JL, Samus QM. Underdiagnosis of dementia: An observational study of patterns in diagnosis and awareness in US older adults. J Gen Intern Med. 2018;33(7):1131–1138. doi:10.1007/s1160 - DOI - PMC - PubMed