Advance Care Planning Among Older Adults with Cognitive Impairment

Factors influencing dementia patients' participation in advance care planning: A meta-analysis

OBJECTIVE

A meta-analysis was conducted based on the available evidence to determine the influencing factors associated with the participation of people with dementia in advance care planning.

METHODS

A keyword search was performed in seven databases, Web of Science, PubMed, Embase, Cochrane Library, CINAHL, Scopus, and Void, to search for eligible studies published from the time of library construction up to February 1, 2024, to examine the factors influencing the participation of dementia patients in advance care planning and its effects. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale (NOS) and the assessment criteria of the Agency for Healthcare Research and Quality (AHRQ). After literature search, data extraction and quality assessment were completed independently by two researchers, meta-analysis was performed using Stata software 15.0 to pool the odds ratios (OR) and 95% confidence intervals (CI). Heterogeneity between studies was assessed using the Cochran chi-square test (Cochran 's Q) and I2 values.

RESULTS

A total of 19 studies were included in this study, and Meta-analysis showed that 8 of the 16 influencing factors were statistically significant: Patients' gender (OR=1.17; 95%: 1.13-1.2), age (OR=1.07; 95%: 1.03-1.1), education (OR=1.98; 95%: 1.65-2.38), race (OR=2.61; 95%: 1.67-4.08), the severity of the dementia (OR=1.46; 95%: 1.34- 1.58), ability to perform activities of daily living (OR=0.99; 95%: 0.97-1.0), religious affiliation (OR=2.24; 95%: 1.23-4.06), and patient income(OR=2.10; 95%: 1.47-2.98) were associated with participation in advance care planning.

CONCLUSIONS

The participation of dementia patients in advance care planning is influenced by gender, age, education, race, dementia severity, ability to perform activities of daily living, religious affiliation and patient income. The results of the study can inform the development of targeted interventions for dementia patients, thereby reducing overtreatment of dementia patients at the end of life and improving patient adherence to hospice care.

Advance care planning and outpatient visits among older adults across cognitive levels

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.