Completion of a Durable Power of Attorney for Health Care: What Does Cognition Have to Do With It?

Perspectives and Experiences of Persons With Dementia With Advance Care Planning: An Integrative Literature Review

OBJECTIVE

An integrative review of the literature on advance care planning (ACP) preferences and practices from the perspective of persons with dementia (PWDs) was conducted, both to learn how health-care providers might engage and empower PWDs in ACP during the early stages of dementia and to identify where researchers should focus future work to improve ACP in this population.

METHODS

In November 2017, CINAHL, Legal Collection, PsycINFO, PubMed, and SocIndex were searched for empirical studies with PWDs as participants and ACP as a topic of interest.

RESULTS

Eighteen articles, which sampled 1304 PWDs, were found, focusing on 4 domains: engagement in and correlates of ACP participation; ability and attitudes toward ACP participation; ACP interventions; and values and preferences for end of life (EOL). Demographics were reported for correlates of participation. Many PWDs held a neutral to negative view toward ACP, although values exploration exercises in interventions were well received. No intervention study reported significant findings for ACP participation. Most PWDs emphasized the importance of family at EOL.

CONCLUSION

Research is needed with methodologically rigorous designs and theoretical frameworks that examine cognitive, psychosocial, and environmental factors influencing ACP attitudes, preferences, and behaviors among PWDs in order to improve engagement among this population.

End-of-life planning activities: an integrated process

This study examined end-of-life planning and whether common characteristics predicted completion of these decisions. Participants in the Nebraska End-of-Life Survey were asked whether they had heard about or completed five plans: a health care power of attorney agreement, a living will, a last will and testament, funeral or burial preplanning, and organ and tissue donation. Logistic regression was used to identify predictors of these outcomes. Predictors of completing end-of-life plans, including funeral and burial preplanning, included older age, higher household income, and higher religiosity. This suggests that all of these decisions may be part of an integrated planning process at the end of life. Further, results from this study indicate that the role of religiosity, found in this study to predict both financial and health care planning, warrants further exploration.