TY - JOUR T1 - Advance Care Planning Prior to Death in Older Adults with Hip Fracture JF - Journal of General Internal Medicine Y1 - 2020 A1 - Kata, Anna A1 - Irena Cenzer A1 - Rebecca L. Sudore A1 - Kenneth E Covinsky A1 - Victoria L. Tang KW - Advance care planning KW - advance directive KW - Hip fracture KW - Older Adults KW - surrogate decision-making AB - Background Although hip fractures in older adults are associated with a high degree of mortality and disability, the use of advance care planning (ACP) in this population is unknown. Objective To determine the prevalence of ACP and need for surrogate decision-making prior to death in older adults with hip fracture and to identify factors associated with ACP. Design Retrospective cohort study using Health and Retirement Study (HRS) interviews linked to Medicare fee-for-service claims data. Participants Six hundred six decedent participants aged 65 or older who sustained a hip fracture during HRS enrollment and had a proxy participate in the exit HRS survey. Main Measures Survey responses by proxies were used to determine ACP, defined by either advance directive completion or surrogate designation, and to assess decision-making at the end of life. Multivariate logistic regression was used to analyze correlates of ACP. Key Results Prior to death, 54.9% of all participants had an advance directive and 68.9% had designated a surrogate decision-maker; however, 24.5% had no ACP. Of the total cohort, 32.5% required decisions to be made about treatment at the end of life and lacked capacity to make these decisions themselves. In this subset, 19.9% had no ACP. In all participants, ACP was less likely in non-white individuals (adjusted odds ratio (aOR) 0.14, 95% CI 0.06–0.31), those with less than a high school education (aOR 0.58, 95% CI 0.35–0.97), and those with a net worth below the median of the cohort (aOR 0.49, 95% CI 0.26–0.72). No clinical factors were found to be associated with ACP completion prior to death. Conclusions A considerable number of older adults with hip fracture required surrogate decision-making at the end of life, of whom one fifth had no ACP prior to death. Clinicians providing care for these patients are uniquely poised to address ACP. SN - 1525-1497 JO - Journal of General Internal Medicine ER - TY - JOUR T1 - Difficulty managing medications and finances in older adults: A 10-year cohort study. JF - Journal of the American Geriatrics Society Y1 - 2017 A1 - Bleijenberg, Nienke A1 - Sei J. Lee A1 - Irena Cenzer A1 - W John Boscardin A1 - Kenneth E Covinsky KW - Financial literacy KW - Older Adults KW - Prescription Medication KW - Risk Factors AB -

BACKGROUND: Difficulty managing medicines and finances becomes increasingly common with advanced age, and compromises the ability to live safely and independently. Remarkably little is known how often this occurs.

OBJECTIVES: To provide population-based estimates of the risk of developing incident difficulty managing medications and finances in older adults.

DESIGN: A prospective cohort study.

SETTING: The Health and Retirement Study (HRS), a nationally representative study of older adults.

PARTICIPANTS: 9,434 participants aged 65 and older who did not need help in managing medications or managing finances in 2002. Follow-up assessments occurred every 2 years until 2012.

MEASUREMENTS: The primary outcomes were time to difficulty managing medications and time to difficulty managing finances. Risk factors such as demographics, comorbidities, functional status, and cognitive status were assessed at baseline. Hazard models that considered the competing risk of death were used to estimate both the cumulative incidence of developing difficulty managing medications and finances and to identify potential risk factors. Analyses were adjusted for age, gender, race, marital status, wealth and education.

RESULTS: The 10 years incidence of difficulty increased markedly with age, ranging from 10.3% (95% CI 9.3-11.6) for managing medications and 23.1% (95% CI 21.6-24.7) for managing finances in those aged 65-69, to 38.2% (95% CI 33.4-43.5) for medicines and 69% (95% CI 63.7-74.3) for finances in those over age 85. Women had a higher probability of developing difficulty managing medications and managing finances than men.

CONCLUSION: This study highlights the importance of preparing older adults for the likelihood they will need assistance with managing their medicines and finances as the risk for having difficulty with these activities over time is substantial.

VL - 65 IS - 7 ER -