Advance care directive prevalence among older Australians and associations with person-level predictors and quality indicators

Kimberly Buck; Linda Nolte; Marcus Sellars; Craig Sinclair; Ben P White; Helana Kelly; Ashley Macleod; Karen M Detering

doi:10.1111/hex.13264

Advance care directive prevalence among older Australians and associations with person-level predictors and quality indicators

Health Expect. 2021 Aug;24(4):1312-1325. doi: 10.1111/hex.13264. Epub 2021 May 1.

Authors

Kimberly Buck¹, Linda Nolte¹, Marcus Sellars^{1

2}, Craig Sinclair^{3

4

5}, Ben P White⁶, Helana Kelly¹, Ashley Macleod¹, Karen M Detering^{1

7}

Affiliations

¹ Advance Care Planning Australia, Austin Health, Heidelberg, Vic, Australia.
² Department of Health Services Research & Policy, Research School of Population Health, Australian National University, ACT, Australia.
³ Australian Research Council Centre of Excellence in Population Ageing Research, University of New South Wales, Sydney, NSW, Australia.
⁴ Neuroscience Research Australia (NeuRA), Sydney, Australia.
⁵ School of Psychology, University of New South Wales, Sydney, NSW, Australia.
⁶ Australian Centre for Health Research Law, Faculty of Law, Queensland University of Technology, Brisbane, Qld, Australia.
⁷ Faculty of Health, Arts and Innovation, Swinburne University, Hawthorn, Vic., Australia.

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Advance Care Planning*
Australia / epidemiology
Documentation
Female
Humans
Prevalence
Quality Indicators, Health Care*