Title | Trends in advance care planning and end-of-life care among persons living with dementia requiring surrogate decision-making. |
Publication Type | Journal Article |
Year of Publication | 2022 |
Authors | Gotanda, H, Walling, AM, Reuben, DB, Lauzon, M, Tsugawa, Y |
Journal | Journal of the American Geriatrics Society |
Volume | 70 |
Issue | 5 |
Pagination | 1394-1404 |
ISSN Number | 1532-5415 |
Keywords | Advance care planning, Dementia, End-of-life care |
Abstract | BACKGROUND: Previous studies have demonstrated positive impacts of advance care planning (ACP) on end-of-life (EOL) care. We sought to examine trends in ACP and EOL care intensity among persons living with dementia who required surrogate decision-making in their final days of life. METHODS: We analyzed the participants of the Health and Retirement Study (HRS), a nationally representative longitudinal panel study of U.S. residents, with dementia 70 years and older who required surrogate decision-making in the final days of life and died between 2000 and 2014. Based on surrogate reports after the death of a participant, our study measured the completion of three specific types of patient-engaged ACP (written EOL care instructions, assignment of a durable power of attorney for healthcare, patient engagement in EOL care discussions) and four measures of EOL care in the final days of life (death in hospital, receipt of life-prolonging treatments, limiting or withholding certain treatments, and receipt of comfort-oriented care). All analyses accounted for the complex survey design of HRS. RESULTS: Among 870 adults (weighted N = 2,812,380) with dementia who died in 2000-2014 and required surrogate decision-making at EOL, only 34.8% of patients participated in all three aspects of ACP, and there was not a significant increase in ACP completion between 2000 and 2014. The receipt of life-prolonging treatments in the final days of life has increased over time (adjusted change per year, 1.4 percentage points [pp]; 95% CI, 0.5 to 2.2 pp; P-for-trend = 0.002), while the percentage of death in hospital, limiting or withholding certain treatments, or comfort-oriented care did not change. CONCLUSIONS: Our findings suggest that the rates of ACP completion have not increased over time despite its potential benefits and life-prolonging treatments are still common among PLWD who require surrogate decision-making, a population who might benefit greatly from early ACP. |
DOI | 10.1111/jgs.17680 |
Citation Key | 12230 |
PubMed ID | 35122231 |
PubMed Central ID | PMC9106854 |
Grant List | R01AG068633 / / National Institute on Aging of the National Institutes of Health / / / Cedars-Sinai Medical Center Clinical Scholars Grant / |