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Advance Care Planning: Social Isolation Matters.
J Am Geriatr Soc. 2019 Dec 18 [Online ahead of print]JA

Abstract

BACKGROUND

Social isolation is a risk factor for poor health that influences the well-being older adults.

OBJECTIVE

We compare advance care planning (ACP) engagement of older adults who were severely socially isolated, socially isolated, and not socially isolated.

DESIGN

Cross-sectional analysis of the 2012 National Health and Aging Trends Study (NHATS).

SETTING

United States of America.

PARTICIPANTS

A total of 2015 older adults (aged ≥65 years) randomly selected from a representative sample of community-dwelling Medicare beneficiaries to participate in an ACP module as part of an annual in-person interview.

MEASUREMENTS

We classified participants in three groups: severely socially isolated, socially isolated, or not socially isolated. ACP refers to three (yes/no) questions regarding whether a participant had a: (1) prior discussion about care preferences in the case of serious illness (EOL Discussion); (2) durable power of attorney (DPOA); and (3) advance directive (AD). We performed logistic regression analyses to examine the association between social isolation and ACP.

RESULTS

Approximately 23% of older adults were either severely socially isolated or socially isolated. Older adults who experienced social isolation were less likely to engage in ACP than those who were not socially isolated. In adjusted analysis, older adults who were socially isolated had lower odds of having an EOL discussion (adjusted odds ratio [AOR] = 0.65; 95% confidence interval [CI] = 0.49-0.87) or having a DPOA (AOR = 0.71; 95% CI = 0.53-0.96) compared to those who were not socially isolated.

CONCLUSION

Social isolation is associated with lower engagement in ACP. Clinicians should identify older adults who are at risk for or experience social isolation as they may benefit from targeted ACP efforts.

Authors+Show Affiliations

Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31851388

Citation

Cudjoe, Thomas K M., et al. "Advance Care Planning: Social Isolation Matters." Journal of the American Geriatrics Society, 2019.
Cudjoe TKM, Boyd CM, Wolff JL, et al. Advance Care Planning: Social Isolation Matters. J Am Geriatr Soc. 2019.
Cudjoe, T. K. M., Boyd, C. M., Wolff, J. L., & Roth, D. L. (2019). Advance Care Planning: Social Isolation Matters. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.16287
Cudjoe TKM, et al. Advance Care Planning: Social Isolation Matters. J Am Geriatr Soc. 2019 Dec 18; PubMed PMID: 31851388.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advance Care Planning: Social Isolation Matters. AU - Cudjoe,Thomas K M, AU - Boyd,Cynthia M, AU - Wolff,Jennifer L, AU - Roth,David L, Y1 - 2019/12/18/ PY - 2019/05/17/received PY - 2019/11/12/revised PY - 2019/11/18/accepted PY - 2019/12/19/entrez KW - advance care planning KW - advance directive KW - durable power of attorney KW - end-of-life discussion KW - social isolation JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc N2 - BACKGROUND: Social isolation is a risk factor for poor health that influences the well-being older adults. OBJECTIVE: We compare advance care planning (ACP) engagement of older adults who were severely socially isolated, socially isolated, and not socially isolated. DESIGN: Cross-sectional analysis of the 2012 National Health and Aging Trends Study (NHATS). SETTING: United States of America. PARTICIPANTS: A total of 2015 older adults (aged ≥65 years) randomly selected from a representative sample of community-dwelling Medicare beneficiaries to participate in an ACP module as part of an annual in-person interview. MEASUREMENTS: We classified participants in three groups: severely socially isolated, socially isolated, or not socially isolated. ACP refers to three (yes/no) questions regarding whether a participant had a: (1) prior discussion about care preferences in the case of serious illness (EOL Discussion); (2) durable power of attorney (DPOA); and (3) advance directive (AD). We performed logistic regression analyses to examine the association between social isolation and ACP. RESULTS: Approximately 23% of older adults were either severely socially isolated or socially isolated. Older adults who experienced social isolation were less likely to engage in ACP than those who were not socially isolated. In adjusted analysis, older adults who were socially isolated had lower odds of having an EOL discussion (adjusted odds ratio [AOR] = 0.65; 95% confidence interval [CI] = 0.49-0.87) or having a DPOA (AOR = 0.71; 95% CI = 0.53-0.96) compared to those who were not socially isolated. CONCLUSION: Social isolation is associated with lower engagement in ACP. Clinicians should identify older adults who are at risk for or experience social isolation as they may benefit from targeted ACP efforts. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/31851388/Advance_Care_Planning:_Social_Isolation_Matters L2 - https://doi.org/10.1111/jgs.16287 DB - PRIME DP - Unbound Medicine ER -
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