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More than 25% of older adults do not discuss end-of-life care

Many elderly adults are not engaging in advance care planning, which includes discussing care and designating a power of attorney, according to findings published in JAMA Internal Medicine.

This may represent a missed opportunity for physicians to have end-of-life discussions with older adults.

"Advance care planning is an iterative process that includes discussions about preferences for end-of-life care, completion of advance directives, and designation of a surrogate decision maker in a durable power of attorney for health care," Krista Lyn Harrison, PhD, from the University of California, San Francisco, and colleagues wrote. "Engagement in [advance care planning] has increased over time. However, the rising tide of [advance care planning] may not have lifted all boats equally. Minorities, those with lower levels of educational attainment, and the poor may not have benefited from rising rates of [advance care planning] to the same extent that white, highly educated, affluent individuals have."

Harrison and colleagues analyzed data from the National Health and Aging Trends Study, which included a nationally-representative sample of 2,015 older adults aged 65 years and older who were Medicare beneficiaries.

They assessed three aspects of advance care planning: end-of-life discussions, durable power of attorney arrangements and completed advance directives. The researchers also evaluated associations between advance care planning engagement and sociodemographic and health characteristics.

Results showed that 1,156 participants (60%) had had an end-of-life discussion, 997 participants (50%) had designated a durable power of attorney and 1,027 participants (52%) completed an advance directive. Further, 723 participants (38%) completed all three advance care planning activities, while 580 participants (27%) had completed none.

In addition, Harrison and colleagues reported that participants who were black or Latino, had low income or low levels of education, or were aged 65 to 74 years were more likely to have engaged in advance care planning activities. They also found that activities participants with dementia or a disability that impaired activities of daily living had a similar prevalence of advance care planning engagement compared to participants without.

"In 2016, [CMS] began reimbursing physicians for engaging Medicare beneficiaries in [advance care planning]," Harrison and colleagues wrote. "While reimbursement is a critical step forward, effective, targeted approaches are needed to ensure increased completion of [advance care planning] among all older adults. Innovative [advance care planning] communication strategies are being developed both for minority populations and populations of older adults with multimorbidity and dementia. In the future, clinicians should use these tailored tools when discussing [advance care planning] with these particularly vulnerable groups." – by Chelsea Frajerman Pardes

Disclosures: The authors report no relevant financial disclosures.