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Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services: multicentre audit study.
BMJ Open. 2019 01 15; 9(1):e025255.BO

Abstract

OBJECTIVES

It is important that the outcomes of advance care planning (ACP) conversations are documented and available at the point of care. Advance care directives (ACDs) are a subset of ACP documentation and refer to structured documents that are completed and signed by competent adults. Other ACP documentation includes informal documentation by the person or on behalf of the person by someone else (eg, clinician, family). The primary objectives were to describe the prevalence and correlates of ACDs among Australians aged 65 and over accessing health and residential aged care services. The secondary aim was to describe the prevalence of other ACP documentation.

DESIGN AND SETTING

A prospective multicentre health record audit in general practices (n=13), hospitals (n=12) and residential aged care facilities (RACFs; n=26).

PARTICIPANTS

503 people attending general practice, 574 people admitted to hospitals and 1208 people in RACFs.

PRIMARY AND SECONDARY OUTCOME MEASURES

Prevalence of one or more ACDs; prevalence of other ACP documentation.

RESULTS

29.8% of people had at least one ACD on file. The majority were non-statutory documents (20.9%). ACD prevalence was significantly higher in RACFs (47.7%) than hospitals (15.7%) and general practices (3.2%) (p<0.001), and varied across jurisdictions. Multivariate logistic regression showed that the odds of having an ACD were positively associated with greater functional impairment and being in an RACF or hospital compared with general practice. 21.6% of people had other ACP documentation.

CONCLUSIONS

In this study, 30% of people had ACDs accessible and a further 20% had other ACP documentation, suggesting that approximately half of participants had some form of ACP. Correlates of ACD completion were greater impairment and being in an RACF or hospital. Greater efforts to promote and standardise ACDs across jurisdictions may help to assist older people to navigate and complete ACDs and to receive care consistent with their preferences.

TRIAL REGISTRATION NUMBER

ACTRN12617000743369.

Authors+Show Affiliations

Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia. Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia.Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia.Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia.Centre for Learning and Research in Palliative Care, Hammond Care, Greenwich Hospital and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30647047

Citation

Detering, Karen M., et al. "Prevalence and Correlates of Advance Care Directives Among Older Australians Accessing Health and Residential Aged Care Services: Multicentre Audit Study." BMJ Open, vol. 9, no. 1, 2019, pp. e025255.
Detering KM, Buck K, Ruseckaite R, et al. Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services: multicentre audit study. BMJ Open. 2019;9(1):e025255.
Detering, K. M., Buck, K., Ruseckaite, R., Kelly, H., Sellars, M., Sinclair, C., Clayton, J. M., & Nolte, L. (2019). Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services: multicentre audit study. BMJ Open, 9(1), e025255. https://doi.org/10.1136/bmjopen-2018-025255
Detering KM, et al. Prevalence and Correlates of Advance Care Directives Among Older Australians Accessing Health and Residential Aged Care Services: Multicentre Audit Study. BMJ Open. 2019 01 15;9(1):e025255. PubMed PMID: 30647047.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services: multicentre audit study. AU - Detering,Karen M, AU - Buck,Kimberly, AU - Ruseckaite,Rasa, AU - Kelly,Helana, AU - Sellars,Marcus, AU - Sinclair,Craig, AU - Clayton,Josephine M, AU - Nolte,Linda, Y1 - 2019/01/15/ PY - 2019/1/17/entrez PY - 2019/1/17/pubmed PY - 2020/2/20/medline KW - advance care directive KW - advance care planning KW - clinical audit KW - prevalence KW - quality in health care SP - e025255 EP - e025255 JF - BMJ open JO - BMJ Open VL - 9 IS - 1 N2 - OBJECTIVES: It is important that the outcomes of advance care planning (ACP) conversations are documented and available at the point of care. Advance care directives (ACDs) are a subset of ACP documentation and refer to structured documents that are completed and signed by competent adults. Other ACP documentation includes informal documentation by the person or on behalf of the person by someone else (eg, clinician, family). The primary objectives were to describe the prevalence and correlates of ACDs among Australians aged 65 and over accessing health and residential aged care services. The secondary aim was to describe the prevalence of other ACP documentation. DESIGN AND SETTING: A prospective multicentre health record audit in general practices (n=13), hospitals (n=12) and residential aged care facilities (RACFs; n=26). PARTICIPANTS: 503 people attending general practice, 574 people admitted to hospitals and 1208 people in RACFs. PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence of one or more ACDs; prevalence of other ACP documentation. RESULTS: 29.8% of people had at least one ACD on file. The majority were non-statutory documents (20.9%). ACD prevalence was significantly higher in RACFs (47.7%) than hospitals (15.7%) and general practices (3.2%) (p<0.001), and varied across jurisdictions. Multivariate logistic regression showed that the odds of having an ACD were positively associated with greater functional impairment and being in an RACF or hospital compared with general practice. 21.6% of people had other ACP documentation. CONCLUSIONS: In this study, 30% of people had ACDs accessible and a further 20% had other ACP documentation, suggesting that approximately half of participants had some form of ACP. Correlates of ACD completion were greater impairment and being in an RACF or hospital. Greater efforts to promote and standardise ACDs across jurisdictions may help to assist older people to navigate and complete ACDs and to receive care consistent with their preferences. TRIAL REGISTRATION NUMBER: ACTRN12617000743369. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/30647047/Prevalence_and_correlates_of_advance_care_directives_among_older_Australians_accessing_health_and_residential_aged_care_services:_multicentre_audit_study_ L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&amp;pmid=30647047 DB - PRIME DP - Unbound Medicine ER -