Inadequate Completion Of Advance Care Directives By Individuals With Dementia: National Audit Of Health And Aged Care Facilities

BMJ Supportive & Palliative Care, Forthcoming

10 Pages Posted: 4 Aug 2021 Last revised: 6 Aug 2021

See all articles by Jamie Bryant

Jamie Bryant

The University of Newcastle - School of Medicine and Public Health, Health Behaviour Research Collaborative

Marcus Sellars

Independent

Craig Sinclair

University of New South Wales (UNSW) - ARC Centre of Excellence in Population Ageing Research (CEPAR)

Karen Detering

Austin Health

Kim Buck

Independent

Amy Waller

affiliation not provided to SSRN

Ben White

Queensland University of Technology - Faculty of Law

Linda Nolte

Austin Health

Date Written: 2021

Abstract

Objectives: (i) Describe the prevalence and type of advance care directives (ACDs) and other advance care planning (ACP) documentation completed by persons with dementia, healthcare providers and others on behalf of a person with dementia; (ii) identify the personal and ACP programme characteristics associated with having ACP documentation in the health record; (iii) identify the personal and ACP programme characteristics associated with having a self-completed ACD.

Methods: A multicentre audit was undertaken in Australian hospitals, general practices and residential aged care facilities. Auditors extracted demographic and ACP data from the records of eligible patients. ACP programme characteristics were provided by a site representative. Logistic and multinomial regression were used respectively to examine the factors associated with completion of any ACP documentation, and self-completion of an ACD by persons with dementia. Results A total of 1388 people with dementia (33.2%) from 96 sites were included. Overall, 60.8% (n=844) had ACP documentation; 31.6% (n=438) had a self-completed ACD and 29.3% (n=406) had an ACP document completed by a health professional or someone else on their behalf. Older participants were more likely to have ACP documented. Multivariate analyses indicated the odds of having self-completed ACP documents, compared with no advance care plan or ACP completed by someone else, were significantly influenced by age, country of birth, setting and whether the site had ACP training, policies or guidelines.

Discussion: While 60% of people with dementia had some form of ACP documentation, only half of the cases in which ACP was documented included an ACD completed by the person themselves.

Note: Funding: This research was funded by the Australian Government Department of Health. JB is supported by a NHMRC-ARC Dementia Research Development Fellowship.

Declaration of Interests: None declared.

Ethics Approval Statement: Ethics approval was obtained from the Austin Health Human Research Ethics Committee (reference HREC/18/Austin/109) and by sites as required.

Keywords: advance care directives, dementia, audit, health care facilities, aged care

JEL Classification: I00, I10, I19, K00, K10, K32, K39

Suggested Citation

Bryant, Jamie and Sellars, Marcus and Sinclair, Craig and Detering, Karen and Buck, Kim and Waller, Amy and White, Ben and Nolte, Linda, Inadequate Completion Of Advance Care Directives By Individuals With Dementia: National Audit Of Health And Aged Care Facilities (2021). BMJ Supportive & Palliative Care, Forthcoming, Available at SSRN: https://ssrn.com/abstract=3883723 or http://dx.doi.org/10.2139/ssrn.3883723

Jamie Bryant

The University of Newcastle - School of Medicine and Public Health, Health Behaviour Research Collaborative ( email )

Australia

Marcus Sellars

Independent ( email )

Craig Sinclair

University of New South Wales (UNSW) - ARC Centre of Excellence in Population Ageing Research (CEPAR) ( email )

Kensington
High St
Sydney, NSW 2052
Australia

Karen Detering

Austin Health ( email )

145 Studley Rd
Heidelberg VIC 3084, Melbourne
Australia

Kim Buck

Independent ( email )

Amy Waller

affiliation not provided to SSRN

Ben White (Contact Author)

Queensland University of Technology - Faculty of Law ( email )

Level 4, C Block Gardens Point
2 George St
Brisbane, QLD 4000
Australia

HOME PAGE: http://staff.qut.edu.au/staff/whiteb/

Linda Nolte

Austin Health ( email )

145 Studley Rd
Heidelberg VIC 3084, Melbourne
Australia

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