Advance Care Directive Prevalence Among Older Australians and Associations with Person-level Predictors and Quality Indicators

Health Expectations, vol. 24(4), pp.1312-1325

14 Pages Posted: 24 Aug 2021

See all articles by Kim Buck

Kim Buck

Independent

Linda Nolte

Austin Health

Marcus Sellars

Independent

Craig Sinclair

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

Ben White

Queensland University of Technology - Faculty of Law

Helana Kelly

affiliation not provided to SSRN

Ashley Macleod

Austin Health

Karen Detering

Austin Health

Date Written: August 2021

Abstract

Background: Advance care planning (ACP) conversations may result in preferences for medical care being documented.

Objective: To explore the uptake and quality of advance care directives (ACDs) among older Australians accessing health and aged care services, by overall ACP documentation prevalence, person-level predictors and ACD quality indicators.

Design and Setting: National multi-centre health record audit in general practices (GP), hospitals and residential aged care facilities (RACF).

Participants: A total of 4187 people aged ≥65 years attending their GP (n = 676), admitted to hospital (n = 1122) or residing in a RACF (n = 2389).

Main Outcome Measures: ACP documentation prevalence by setting and type including person-completed ACDs and non-ACD documents (completed by a health professional or someone else); person-level predictors and quality indicators of ACDs.

Results: Overall ACP documentation prevalence was 46.5% (29.2% weighted). ACD prevalence was 25.3% (14.2% weighted). Unweighted ACD prevalence was higher in RACFs (37.7%) than in hospitals (11.1%) and GPs (5.5%). 35.8% of ACP documentation was completed by a health professional (9.7% weighted), and 18.1% was completed by someone else (10.6% weighted). Having an ACD was positively associated with being female, older, having two or more medical conditions, receiving palliative care, being divorced/separated and being in a RACF. Only 73% of ACDs included full name, signature, document date and witnessing.

Conclusions and Contribution: Low ACP documentation prevalence and a lack of accessible, person-completed and quality ACDs represent an important ACP implementation issue. Low prevalence is complicated by poor document quality and a higher prevalence of documents being completed by someone other than the person.

Keywords: advance care directive, advance care planning, aged care service, general practice, health service, prevalence

JEL Classification: I00, I10, I19, K00, K10, K19, K32, K39

Suggested Citation

Buck, Kim and Nolte, Linda and Sellars, Marcus and Sinclair, Craig and White, Ben and Kelly, Helana and Macleod, Ashley and Detering, Karen, Advance Care Directive Prevalence Among Older Australians and Associations with Person-level Predictors and Quality Indicators (August 2021). Health Expectations, vol. 24(4), pp.1312-1325, Available at SSRN: https://ssrn.com/abstract=3909544

Kim Buck

Independent ( email )

Linda Nolte

Austin Health ( email )

145 Studley Rd
Heidelberg VIC 3084, Melbourne
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

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/

Helana Kelly

affiliation not provided to SSRN

Ashley Macleod

Austin Health ( email )

145 Studley Rd
Heidelberg VIC 3084, Melbourne
Australia

Karen Detering

Austin Health ( email )

145 Studley Rd
Heidelberg VIC 3084, Melbourne
Australia

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