Abstract
ContextAdvance care planning (ACP) becomes more relevant with deteriorating health or increasing age. People might be more inclined to engage in ACP as they feel that they are approaching end of life. The perception of approaching end of life could be quantified as subjective remaining life expectancy (SRLE). ObjectivesFirst, to describe the prevalence of ACP with health care providers or written directives (“formal engagement in ACP”) and ACP with loved-ones (“informal engagement in ACP”) among older persons in the general population in The Netherlands. Second, to assess the association between SRLE and engagement in ACP. MethodsCross-sectional study using data from the Longitudinal Aging Study Amsterdam (LASA) measurement wave of 2015–2016. Participants (n = 1585) were aged ≥ 57 years. ResultsMedian age was 69.4 years (IQR: 64.1–76.7), and median SRLE 25.9 years (17.7–36.0). Formal engagement in ACP was present in 32.6%, informal without formal engagement in 45.8%, and 21.6% was not engaged in ACP. For respondents with SRLE < 25 years, there was a nonstatistically significant association between SRLE and engagement in ACP (aOR: 0.97; 95% CI: 0.93–1.01; P= .088), and a statistically significant, small association with formal vs. informal engagement in ACP (aOR: 0.96; 0.93–0.99; P= .009). For respondents with SRLE ≥ 25 years there was no association between SRLE and engagement in ACP. ConclusionThe perception of approaching end of life is associated with higher prevalence of formal engagement in ACP, but only for those with SRLE < 25 years. For clinicians, asking patients after their SRLE might serve as a starting point to explore readiness for ACP.
Highlights
Advance care planning (ACP) is a process that helps people to receive medical care that is consistent with their values, goals and preferences.[1]
Formal engagement in ACP was present in 32.6%, informal without formal engagement in 45.8%, and 21.6% was not engaged in ACP
Key Words Advance care planning, life expectancy, goals of care, decision making, patient preferences. This cross-sectional study describes the prevalence of advance care planning (ACP) and the relationship between subjective remaining life expectancy and engagement in ACP among older people in The Netherlands
Summary
Advance care planning (ACP) is a process that helps people to receive medical care that is consistent with their values, goals and preferences.[1]. Engagement in ACP is usually operationalized as having discussed preferences for future medical treatment and care with health care professionals or having made an advance directive. 9-12 Notwithstanding its importance, ACP with loved-ones without involvement of health care professionals might not be sufficient to assure that future medical treatment and care will be consistent with patients’ goals and preferences. SRLE is a comprehensive measure of a person’s overall condition, as people will incorporate their age, perceived health status, and other important factors that might increase or decrease their mortality risk. The first aim of this study is to describe the prevalence of ACP with health care providers or written directives (defined as “formal engagement in ACP” in this study) and ACP with loved-ones (defined as “informal engagement in ACP”) among older persons in the general population in The Netherlands
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