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Rahemi Z, Bacsu JDR, Shalhout SZ, Sabet M, Sirizi D, Smith ML, Adams SA. Past Disparities in Advance Care Planning Across Sociodemographic Characteristics and Cognition Levels in the United States. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.09.24307125. [PMID: 38766186 PMCID: PMC11100925 DOI: 10.1101/2024.05.09.24307125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
We aimed to examine past advance care planning (ACP) in U.S. older adults across different sociodemographic characteristics and cognition levels. We established the baseline trends from 10 years ago to assess if trends in 2024 have improved upon future data availability. We considered two legal documents in the Health and Retirement Study 2014 survey as measures for ACP: a living will and durable power of attorney for healthcare (DPOAH). Logistic regression models were fitted with outcome variables (living will, DPOAH, and both) stratified by cognition levels (dementia/impaired cognition versus normal cognition). Predictor variables included age, gender, ethnicity, race, education, marital status, rurality, everyday discrimination, social support, and loneliness. Age, ethnicity, race, education, and rurality were significant predictors of ACP (having a living will, DPOAH, and both the living will and DPOAH) across cognition levels. Participants who were younger, Hispanic, Black, had lower levels of education, or resided in rural areas were less likely to complete ACP. Examining ACP and its linkages to specific social determinants is essential to understanding disparities and educational strategies needed to facilitate ACP uptake among different population groups. Accordingly, this study aimed to examine past ACP disparities in relation to specific social determinants of health and different cognition levels. Future studies are required to evaluate whether existing disparities have improved over the last 10 years when 2024 data is released. Addressing ACP disparities among diverse populations, including racial and ethnic minorities with reduced cognition levels, is crucial for enhancing health equity and access to care.
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Affiliation(s)
- Zahra Rahemi
- School of Nursing, Clemson University Clemson, SC, 29634-0743
| | | | - Sophia Z. Shalhout
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Mike Toth Cancer Research Center, Mass Eye and Ear, Harvard Medical School Boston, Massachusetts, USA, 02114
| | - Morteza Sabet
- School of Mechanical and Automotive Engineering, College of Engineering, Computing and Applied Sciences, Clemson University 4 Research Dr, Greenville, SC 29607
| | - Delaram Sirizi
- Department of Health Sciences, College of Behavioral, Social, and Health Sciences, Clemson University, Clemson SC 29634
| | - Matthew Lee Smith
- Department of Health Behavior, School of Public Health, Center for Community Health and Aging Texas A&M University, College Station, TX 77843
| | - Swann Arp Adams
- College of Nursing and the Department of Epidemiology & Biostatistics, University of South Carolina Columbia, SC 29208
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Yunus RM, Duivenbode R, Padela AI. American Muslim Engagement With Advance Care Planning: Insights From a Community Survey. Am J Hosp Palliat Care 2024; 41:405-413. [PMID: 37641456 DOI: 10.1177/10499091231198216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Background and Objectives: Advance Care Planning (ACP) is a critical tool in advancing patient self-determination in health care delivery. Despite increasing research into racial/ethnic minorities' engagement with ACP in the US, studies on Muslim Americans are relatively scarce. We aimed to examine levels of ACP engagement among Muslim adults and measure associations between socio-demographic and religiosity characteristics and ACP engagement. Methodology: This was a survey study among Muslims attending mosque seminars in Chicago and Washington DC. Religiosity characteristics were assessed using a modified version of the Duke University Religion Index (DUREL) and the Psychological Measure of Islamic Religiousness (PMIR). ACP engagement was measured by the 4-item ACP Engagement Survey (4-ACPES) and 2 additional items covering ACP religious dimensions. Statistical analyses were performed using SPSS 28.0. Results: Out of 152 respondents, 56.2% to 72.6% were in the pre-contemplation stage of ACP across the 6 ACP items. Bivariate analyses showed that ACP engagement was correlated with participant age, ethnicity, duration of stay in the US and country of birth. Multivariable analyses demonstrated no association between religiosity characteristics and ACP engagement; independent predictors of ACP engagement were race/ethnicity (being South Asian), country of birth (born outside the US) and duration of stay in the US (longer years). Discussion/Conclusion: Our study suggests that American Muslims are largely unprepared to engage with ACP. Moreover, religiosity does not predict ACP engagement. We call for greater community outreach and educational programs that instill awareness and knowledge on the importance of ACP, and provide resources for tailored religiously-oriented conversations that assist individuals with ACP.
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Affiliation(s)
- Raudah M Yunus
- Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Malaysia
| | - Rosie Duivenbode
- Medical College of Wisconsin, Milwaukee, WI, USA
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Rahemi Z, Bacsu JDR, Sefcik JS, Sadafipoor MS, Demiris G, Adams SA. Advance care planning and outpatient visits among older adults across cognitive levels. AGING AND HEALTH RESEARCH 2023; 3:100166. [PMID: 38076608 PMCID: PMC10703190 DOI: 10.1016/j.ahr.2023.100166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
Advance care planning (ACP) can help reduce end-of-life care challenges for persons with Alzheimer's disease and related dementia and their care partners. Building on our previous work, we examined the impact of ACP on outpatient/doctor visits in older adults with dementia/impaired cognition and normal cognition. Using datasets from the 2014 Health and Retirement Study (HRS), we conducted a cross-sectional study of 17,698 participants aged 51 years and older. Our analyses included survey descriptive and logistic regression procedures. Our findings indicated that having at least one ACP measure was significantly associated with a higher mean number of outpatient visits in both cognition groups. Based on our findings, we recommend considering healthcare access and use as an intervening variable in future ACP research.
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Affiliation(s)
- Zahra Rahemi
- Clemson University School of Nursing, 605 Grove Road, Greenville, SC 29605, USA
| | | | - Justine S. Sefcik
- Drexel University College of Nursing and Health Professions, Philadelphia, PA, USA
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Rahemi Z, Malatyali A, Adams SA, Jarrín OF, Demiris G, Parker V, Anaraky RG, Dye CJ. Advance Care Planning Among Older Adults with Cognitive Impairment. Am J Hosp Palliat Care 2023; 40:1182-1189. [PMID: 36541134 PMCID: PMC10282104 DOI: 10.1177/10499091221146255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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.
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Affiliation(s)
- Zahra Rahemi
- School of Nursing, Clemson University, Clemson, SC, USA
| | - Ayse Malatyali
- Nursing Systems Department, College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Swann A. Adams
- Department of Epidemiology & Biostatistics, College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Olga F. Jarrín
- School of Nursing, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - George Demiris
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Cheryl J. Dye
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
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Glyn-Blanco MB, Lucchetti G, Badanta B. How do cultural factors influence the provision of end-of-life care? A narrative review. Appl Nurs Res 2023; 73:151720. [PMID: 37722788 DOI: 10.1016/j.apnr.2023.151720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/22/2023] [Accepted: 07/28/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Culture influences the way in which patients, families and professionals provide care and undergo decision-making at the end of life. OBJECTIVE Therefore, our research questions were: How do cultural aspects influence the needs, perceptions, and experiences of patients and their families in end-of-life care? What implications does cultural diversity have for professionals who care for individuals at the end of life? METHODS A narrative review was conducted between June and July 2022. Articles published between 2017 and 2022 in peer-reviewed journals were included. RESULTS A total of 43 studies were included. Our findings were grouped into four themes: 1) places to die and preferences about healthcare interventions (e.g. parts of the immigrant population tend to receive more aggressive and invasive interventions); 2) advance care planning and verbalization of death (e.g. less use of ACP in some minority groups); 3) rituals and family involvement during healthcare; 4) professionals addressing multiculturalism in care at the end of life (e.g. lack of training in addressing the context of multiculturalism). CONCLUSIONS These findings could contribute to making professionals more aware of cultural aspects that influence the process of death and highlight the need for further training in the handling of such situations.
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Affiliation(s)
| | - Giancarlo Lucchetti
- Department of Medicine, School of Medicine, Federal University of Juiz de Fora, 36036-900, Brazil
| | - Bárbara Badanta
- Research Group under the Andalusian Research CTS 1050 "Complex Care, Chronic and Health Outcomes", Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Universidad de Sevilla, Spain.
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Rahemi Z, Malatyali A, Wiese LAK, Dye CJ. End-of-Life Care Planning in Diverse Individuals Across Age Groups: A Proposed Conceptual Model of Nursing. J Nurs Care Qual 2023; 38:319-326. [PMID: 36947814 PMCID: PMC10442095 DOI: 10.1097/ncq.0000000000000705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND End-of-life planning helps nurses meet the needs of their patients at a crucial time of life. PURPOSE This article presents a conceptual model of end-of-life care planning for nurses, especially those in palliative and hospice care, focusing on holistic nursing views. METHODS Based on a literature review, we developed a new conceptual model illustrating the concepts and dimensions of end-of-life care planning among diverse individuals across countries, life spans and age groups, ethnographies, and residential statuses. RESULTS This conceptual model includes 3 concepts: personal factors, stakeholders, and environmental and social factors. Each concept encompasses multiple dimensions. The concepts are interrelated and directly related to end-of-life care planning. CONCLUSION This work addresses the need for a comprehensive end-of-life care planning model and can help enhance the quality of end-of-life care. This article identifies implications for nursing education, practice, and research.
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Affiliation(s)
- Zahra Rahemi
- Clemson University School of Nursing, Greenville, South Carolina (Dr Rahemi); University of Central Florida College of Nursing, Orlando (Dr Malatyali); Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton (Dr Wiese); and Department of Psychology, Professor Emerita, Department of Public Health Sciences, Clemson University, Clemson, South Carolina (Dr Dye)
| | - Ayse Malatyali
- Clemson University School of Nursing, Greenville, South Carolina (Dr Rahemi); University of Central Florida College of Nursing, Orlando (Dr Malatyali); Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton (Dr Wiese); and Department of Psychology, Professor Emerita, Department of Public Health Sciences, Clemson University, Clemson, South Carolina (Dr Dye)
| | - Lisa Ann Kirk Wiese
- Clemson University School of Nursing, Greenville, South Carolina (Dr Rahemi); University of Central Florida College of Nursing, Orlando (Dr Malatyali); Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton (Dr Wiese); and Department of Psychology, Professor Emerita, Department of Public Health Sciences, Clemson University, Clemson, South Carolina (Dr Dye)
| | - Cheryl J. Dye
- Clemson University School of Nursing, Greenville, South Carolina (Dr Rahemi); University of Central Florida College of Nursing, Orlando (Dr Malatyali); Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton (Dr Wiese); and Department of Psychology, Professor Emerita, Department of Public Health Sciences, Clemson University, Clemson, South Carolina (Dr Dye)
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