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
Date Written: August 2021
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: Suggested Citation