Durable Power Of Attorney For Health Care Research Articles

Advance Care Planning Among Older Adults with Cognitive Impairment.

In this study, we used data from the Health and Retirement Study (HRS) to investigate factors associated with older adults' engagement with advance care planning (ACP) across varying levels of cognitive functioning status. Our analysis used a sample of 17,698 participants in the HRS 2014 survey. Survey descriptive procedures (Proc SurveyMeans, Proc SurveyFreq) and logistic regression procedures (Proc SurveyLogistic) were used. Race, ethnicity, level of cognition, education, age, and number of chronic diseases consistently predicted ACP. Participants with lower levels of cognition were less likely to have a living will and durable power of attorney for healthcare (DPOAH). African American and Hispanic participants, younger participants, and those with lower cognition and education levels were less likely to engage in ACP. Marital status and loneliness predicted ACP engagement. Some results varied across the cognition cohorts. Our results indicated that sociodemographic status, together with health and cognitive status, has a significant role in predicting ACP. The results can provide valuable insights on ACP for older adults with or at risk of Alzheimer's disease and related dementia and other cognitive impairments, caregivers, families, and healthcare providers.

Impact of Chronic Conditions, Healthcare Utilization, and Demographics on Advance Care Planning.

Context: Unraveling the intricacies of what factors influence advance care planning (ACP) is an ongoing research challenge. Research shows much ACP is crisis-based and takes place at the end of life. Complicating this late-stage approach may be demographic differences based on race, ethnicity and socioeconomic status. Objective: We examined the relationship between demographic factors, chronic health conditions, and healthcare utilization in predicting who was most likely to engage in ACP activities, including designating a durable power of attorney for healthcare (DPOAHC), having a living will, and discussing wishes with family or others. Methods: We conducted a secondary analysis using 2018 Health and Retirement Study (HRS) exit data provided by a proxy for the deceased participant that matched the 2016 survey participant data (N = 884). Generalized linear mixed models were used for the analysis. Results: The number of chronic health conditions and healthcare utilization were not associated with ACP activities, but several of the demographic variables showed strong associations. Participants who were female, white, older, and from a higher socioeconomic status were more likely to have engaged in ACP. Conclusion: People continue to defer ACP discussions and documentation end of life or when facing medical crises. More needs to be done to reach out to younger adults, racial minorities, and those with lower socioeconomic status to encourage them to engage in ACP.

Abstract P5-15-03: The effectiveness of an advance care appointment companion to increase completion of advance care planning among patients with metastatic breast cancer

Abstract Previous research has demonstrated that patients express a desire to discuss advance care planning (ACP). ACP has been associated with numerous positive outcomes including improved patient satisfaction, improved quality of life in terminal illness, and better psychological outcomes. Additionally, ACP has been related to peace of mind that wishes will be followed, less hospital re-admissions, and less use of extreme treatments close to death. Furthermore, it has been linked to increased use of hospice and palliative care and increased concordance between preferred care and the care delivered. However, despite the documented benefit of ACP, these conversations often do not occur due to discomfort with the topic or are communicated inadequately. Documentation rates of ACP in oncology patients have been as low as 10%, with rates of documentation increasing between 30-40% in intervention studies. Specific to women with metastatic breast cancer (MBC), one study found that 66% had written advance directives, but providers were only aware of these in 14% of the cases. Thus, the present study aimed to examine the effectiveness of an online Advance Care Appointment Companion (ACAC) decision-support tool to improve ACP communication between MBC patients and their oncologist and increase completion rates of ACP documents. Data were collected from 68 patients with MBC during their medical oncology appointments (Time 1) and three months later (Time 2) at the Koontz Center for Advanced Breast Cancer. At their Time 1 clinic visit, patients were introduced to and enrolled on the ACAC platform and then completed questions in the clinic or at home about completion status of a healthcare directive and durable power of attorney (DPOA) for healthcare, comfort in discussing ACP with their care team and loved ones, goals of care at end of life, and discussion topics about ACP for upcoming visits. A summary of these responses with a provider prompt script was securely sent to the oncologist prior to each subsequent appointment over the three-month study period. The oncologist used this summary and scripting to help navigate ACP conversations during each appointment. Descriptive statistics and McNemar’s test were conducted to examine changes in rates of ACP document completion and patient reported levels of comfort in discussing ACP. Majority of the sample was female (n=68, 100%), white (n=57, 84%), married (n=36, 53%), with a mean age of 64 years. At baseline, 41% of patients reported having a completed healthcare directive and 49% reported having a completed DPOA for healthcare, but only 12% had a healthcare directive and 24% had a DPOA in their electronic medical record (EMR). To-date, 35% (n=24) have a healthcare directive and 47% (n=32) have a notarized DPOA in their EMR; McNemar’s test showed a significant increase in the proportion of patients who completed ACP documents at Time 2 (p< .001). At baseline, 74% of patients reported feeling comfortable discussing ACP with their care team and 69% reported feeling comfortable discussing ACP with their loved ones. Of note, 35% reported that they were unsure if they would want artificial nutrition, 37% reported they were unsure if they would want dialysis, and 37% reported that they were unsure if they would want resuscitation in the event that their heart stops. On average, ACP conversations during medical appointments took 5 minutes to discuss. Preliminary results suggest that the ACAC is an effective tool to facilitate discussion about ACP, resulting in significantly increased completed ACP documents in patient’s medical records. Assessment of patient-reported outcomes on comfort with discussing ACP and goals of care at Time 2 is ongoing. Results also revealed the potential for this tool to help foster communication about the intricacies of ACP as a large portion of patients reported that they were unsure about decisions that need to be made about end of life care. Citation Format: Kadie M Harry, Cathy E Mitchell, Loic Nijiakin, Arabella Sykes, Timothy J Pluard. The effectiveness of an advance care appointment companion to increase completion of advance care planning among patients with metastatic breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-15-03.

Advance Directive Completion Among Older American Couples: A Dyadic Perspective on the Role of Cognitive Function and Other Factors.

Dyadic perspective is scarce in existing advance directive (AD) literature. Particularly, the significance of one's own and/or one's partner's cognitive function on AD remains unknown. This study investigates the relationship of cognitive function and other factors with AD completion within the spousal context. Data from the Health and Retirement Study (2014-2015) were used. Older heterosexual couples (age ≥65) married for 10+ years were asked if they had a living will and/or appointed a durable power of attorney for health care (DPAHC). Structural equation models examined the actor and partner effects of sociodemographic, health, and couple-level characteristics on wife's and husband's AD, respectively. Moderate spousal interdependence was observed in living will (kappa coefficient, κ = .60) and DPAHC (κ = .53). Older age and higher education were related to both spouses having AD. Less household wealth and being racial/ethnic minority were associated with a lower probability of having AD. Notable gender contrasts in actor and partner effects were found. Wife's higher level of cognitive function was associated with husband's AD completion. Contrarily, husband's lower level of cognitive function was associated with wife's AD completion. Retirement status had primarily actor effects for both husbands and wives. More chronic conditions were linked to husband's AD completion. The spousal interdependence of AD warrants practitioner efforts to facilitate family-oriented end-of-life planning. Wives and husbands may have different thoughts regarding their spouse's cognitive capacity to surrogate. Facilitating couple-based discussions may be a feasible approach to promote engagement with AD among older adults.

Marital Status and Gender Differences in End-of-Life Planning

Less than half of older adults make formal preparations to control difficult life transitions, yet planning can mitigate negative outcomes that accompany changes. To better understand multiple forms of end-of-life planning behaviors and the effect of demographic characteristics, we use data from the Understanding America Study (N=1812; aged 60+). We explored gender and marital differences in whether respondents created a will, living will, or declared a durable power of attorney for health care (DPOAHC), and who was chosen as DPOAHC (i.e., spouse, child, other relative). T-tests determined no significant gender differences in declaring a DPOAHC, creating a will, or living will. An analysis of variance (F=13.422, df=3, p<0.001) found married respondents more likely to declare a DPOAHC than separated/divorced (p<0.001) and never married respondents (p=0.002). Divorced respondents were less likely to declare a DPOAHC compared to widowed respondents (p<0.001) and widowed respondents were more likely compared to never married respondents (p=0.001). Additional analyses found the same pattern in who created a will or living will. A follow-up analysis of variance found no gender differences within marital status categories (i.e., married men versus married women). Overall, respondents who were never married were less likely to have prepared any forms of end-of-life planning. These results highlight the importance of having close relationships on the level of preparedness for end-of-life planning. Additional implications include increasing awareness about end-of-life planning for more vulnerable audiences. Future analyses will integrate findings regarding financial DPOAHC and examine other socio-demographic characteristics, such as education and race.

The Association Between Hearing Loss and Completion of Advance Care Planning Among Older Adults

Background: Ensuring access to quality end-of-life (EOL) care for all older adults is emerging public health concern. Hearing loss (HL) is the third most common chronic disease affecting older adults and a major impediment to access healthcare services. However, little is known about the impact of HL on advance care planning for older adults. Method: A sample of 1,862 older adults (≥65 years) was drawn from the National Health and Aging Trends Study (NHATS). HL was determined by self-report and advance care planning was measured by asking if an individual completed living wills or the Durable Power of Attorney for Health Care (DPAHC). Covariates included age, gender, race, marital status, education, religion, nativity, depression, region, facility status, regular doctor availability, Medicaid, hospitalization, cognition, perceived health status and a presence of chronic disease. Results: Descriptive statistics revealed that nearly 67% of older adults with HL completed the DPAHC, and the majority of them (71%) also had living wills. Multivariable logistic regression analyses showed that HL was significantly associated with completion of DPAHC and living wills, after controlling for a list of covariates (OR=0.50, p<0.05). Conclusions: The findings show HL is a significant predictor of completion of any type of advance directives. Facilitating effective communication in advance care planning for older adults with HL is needed. Healthcare provider should make health information accessible to them to get quality EOL care.

The association between the number of chronic health conditions and advance care planning varies by race/ethnicity

Objectives: Although a national consensus exists on the need to increase the rates of advance care planning (ACP) for all adults, racial/ethnic differences in ACP have been consistently observed. This study investigated the intersection of racial/ethnic differences and the number of chronic health conditions on ACP among middle-aged and older adults in the United States.Method: Responses from 8,926 adults from the 2014 wave of the Health and Retirement Study were entered into multilevel hierarchical logistic regression analyses with generalized linear mixed models to predict ACP focused on assigning a durable power of attorney for healthcare (DPOAHC) and having a written living will after adjusting for covariates.Results: We found a significant positive relationship between the number of chronic health conditions and ACP. Non-Hispanic Blacks/African Americans and Hispanics were less likely to engage in ACP than non-Hispanic Whites/Caucasians. Racial/ethnic disparities were even starker for completing a living will. The number of chronic health conditions had a greater effect for Hispanics than non-Hispanic Whites/Caucasians on ACP through assigning a DPOAHC and having a living will. The initial disparity in ACP among Hispanics with no chronic health conditions decreased as the number of chronic health conditions increased.Conclusion: Our findings suggest that more chronic health conditions increase the likelihood that Hispanics will complete ACP documents. These ACP differences should be highlighted to researchers, policymakers, and healthcare professionals to reduce stark racial/ethnic disparities in ACP. A comprehensive and culturally caring decision-making approach should be considered when individuals and families engage in ACP.

Advance Care Planning: Contemporary Issues and Future Directions.

Advance care planning (ACP) is widely considered an essential step toward achieving end-of-life care that is consistent with the preferences of dying patients and their families. ACP comprises a living will and a durable power of attorney for health care (DPAHC); these tools enable patients to articulate and convey their treatment preferences when they are still cognitively intact. In this article, we describe the strengths, weaknesses, and correlates of ACP in the United States, with attention to race and socioeconomic disparities therein. We then discuss other public policies and community programs designed to increase both the number of older adults who articulate their preferences for end-of-life care, and efficacy of ACP for ensuring that patients’ end-of-life treatment preferences are met. We describe the characteristics, strengths, and limitations of Physician Orders for Life Sustaining Treatment (POLSTs), and describe community programs, educational interventions, and public policies aimed toward increasing the prevalence and efficacy of end-of-life preparations. A key policy advance in the early 2010s has been Medicare coverage of one doctor–patient consultation session regarding end-of-life issues; we highlight the potentials and possible pitfalls of this policy. We conclude by identifying areas for future research, and highlighting practices from other nations that may help improve quality of end-of-life care in the United States.

Low Completion and Disparities in Advance Care Planning Activities Among Older Medicare Beneficiaries

Letters Chicago; Ann Thomas, MD, MPH, Oregon Public Health Division, Portland; Teri Moser Woo, PhD, Pacific Lutheran University, Tacoma, Washington; Rachel M. Zetts, The Pew Charitable Trusts, Washington, DC. Conflict of Interest Disclosures: Dr Hersh has received funding from the CDC, the Agency for Healthcare Research and Quality, Pfizer/Joint Commission, and Merck. No other conflicts are reported. Funding/Support: This project was made possible through a partnership with the CDC Foundation. Support for this project was provided by Pew Charitable Trusts. Role of the Funder/Sponsor: The CDC participated in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The Pew Charitable Trusts participated in the interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The Pew Charitable Trusts sponsored in-person and telephone author meetings and supported some author travel to in-person meetings. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC. Additional Contributions: Tia Carter, MS, Allan Coukell, BSc Pharm, and Elizabeth Jungman, JD, MPH, of The Pew Charitable Trusts assisted in convening author meetings. They did not receive any compensation for their role in the study. 1. The White House. National action plan for combating antibiotic resistant bacteria. https://www.whitehouse.gov/sites/default/files/docs/national_action _plan_for_combating_antibotic-resistant_bacteria.pdf. Accessed August 3, 2015. 2. Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA. 3. Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol. 2010;105(4):259-273. 4. Piccirillo JF, Mager DE, Frisse ME, Brophy RH, Goggin A. Impact of first-line vs second-line antibiotics for the treatment of acute uncomplicated sinusitis. JAMA. 5. Capra AM, Lieu TA, Black SB, Shinefield HR, Martin KE, Klein JO. Costs of otitis media in a managed care population. Pediatr Infect Dis J. 2000;19(4): Table 1. Characteristics of Participants Participants, No. (%) a Variable Sociodemographic characteristics Age, y Sex Female Male Race/ethnicity White Black/African American Hispanic/Latino English-speaking Spanish-speaking Other Education High school diploma or less Greater than high school Annual income, b $ Health-related characteristics Self-rated health Excellent or very good Good Fair or poor Dementia c None Possible or probable dementia Low Completion and Disparities in Advance Care Planning Activities Among Older Medicare Beneficiaries Advance care planning (ACP) is an iterative process that in- cludes discussions about preferences for end-of-life (EOL) care, completion of advance directives (AD), and designation of a surrogate decision maker in a durable power of attorney for health care (DPOA). 1,2 Engagement in ACP has increased over time. 3 However, the rising tide of ACP may not have lifted all boats equally. Minorities, those with lower levels of educa- tional attainment, and the poor may not have benefited from rising rates of ACP to the same extent that white, highly edu- cated, affluent individuals have. Rates of ACP by older Lati- nos in particular are unknown. Further, we do not know if ACP uptake is greater among those in worse health and with poorer prognoses. Methods | We used data from the National Health and Aging Trends Study (NHATS), a longitudinal cohort study using a nationally representative sample of community-dwelling Medi- care beneficiaries ages 65 years and older (2011 round 1 re- sponse rate, 71%; 2012 round 2 response rate, 86%). 4 This cross- sectional analysis used a random one-third sample of 2015 d Number of chronic medical conditions None Number of ADLs requiring help e 1 or 2 (continued) participants who responded to a supplemental module on ACP fielded in 2012. This study was considered exempt by the institutional review board of the University of California, San Francisco. Outcome variables included 3 self-reported elements of ACP: (1) discussing with any individual the medical treat- ment desired if seriously ill in the future (EOL discussion), (2) having legal arrangements for a proxy to make decisions about medical care (DPOA), or (3) having written instructions about JAMA Internal Medicine December 2016 Volume 176, Number 12 (Reprinted) jamainternalmedicine.com Copyright 2016 American Medical Association. All rights reserved. Downloaded From: http://jamanetwork.com/pdfaccess.ashx?url=/data/journals/intemed/935892/ by a UCSF LIBRARY User on 06/15/2017

Caregiving Youth Knowledge and Perceptions of Parental End-of-Life Wishes in Huntington’s Disease

ABSTRACTKnowledge of patient end-of-life (EOL) wishes and discussions are vital for family caregivers, including children and youth who may be in caregiving roles (“young carers” or “caregiving youth”). However, little is known about caregiving youth awareness and perceptions of EOL issues. This study sought to explore caregiving youth knowledge of EOL wishes and their willingness for EOL discussions. Face-to-face interviews with 40 caregiving youth ages 10–20, who have a parent with Huntington’s disease (HD), provided information about their knowledge of the presence of their ill parent’s living will (LW) and durable power of attorney for health care (DPAHC), and willingness to talk with the parent about EOL choices and possibility of death. Less than one-half of the participants were aware of the parent’s LW or DPAHC. Content analysis revealed themes in reasons to want or not want EOL discussion with the parent: respect for the parent’s wishes, caregiving youths’ opinion not valued, and avoidance of EOL issues. Themes also included reasons to not want discussion with the parent about possibility of death: protecting the parent, parent in denial, parent not ready, and realization of the terminal outcome. Findings suggest HD patients and their caregiving youth need support for open EOL discussions, and could benefit from educational programs and support groups around EOL issues.

Does Volunteering Experience Influence Advance Care Planning in Old Age?

ABSTRACTAdvance care planning (ACP) increases the likelihood patients will receive end-of-life care that is congruent with their preferences and lowers stress among both patients and caregivers. Previous efforts to increase ACP have mainly focused on information provision in the very late stage of life. This study examines whether a relationship exists between volunteering and ACP, and whether this relationship is associated with social support. The sample comprises 877 individuals who were aged 55+ in 2008, and were deceased before 2010. The sample is derived from seven waves (1998–2010) of data from the Health and Retirement Study. Logistic regression results showed that overall ACP and durable power of attorney for health care (DPAHC) were both higher (OR = 1.61 and 1.71, respectively) for older adults with volunteering experience in the past 10 years than those without such experience. Available social support (relatives and friends living nearby) was not associated with the relationship between volunteering and ACP. Other factors related to ACP included poorer health, death being expected, death due to cancer, older age, and being a racial minority. Involving older people in volunteer work may help to increase ACP. Future research is encouraged to identify reasons for the association between volunteering and ACP.

P-95 The effects of education on advance healthcare planning among independent, community-dwelling older adults

Background There are many types of advance directives. Most common being the Durable Power of Attorney for Healthcare (DPAHC). In this type of advance directive the patient chooses a healthcare representative, who may be a friend, spouse, or family member who will be responsible for healthcare decisions and will act in the patient’s best interest once the patient is incapacitated. In California the DPAHC was replaced by the Advance Health Care Directives AHCD in July 2000 based on the Natural Death Act of 1972. The problem is the lack of education about AHCP. End-of-life decisions are difficult to discuss for patients, family, and healthcare providers (HCP). Aim Purpose was to determine the effectiveness of AHCP education among independent community-dwelling older adults >60 and to promote communication about end-of-life preferences among participants, family-members/HCP. Methods Pre-test assessed knowledge level using face-to-face surveys including demographic data with 20 participants at retirement self-contained apartments. Post-test survey was conducted after an educational presentation. Descriptive/inferential statistical analysis was used. Results Statistically significant overall improvement p = 0.001 was achieved. Many older adults did not like discussing end-of-life issues due to lack of knowledge of health, fear or guilt. Three most important issues were: not to be a burden to families; being off machines that extend life support; being pain free. Discussion Open communication among clinicians/family/patients will prepare patients from transition-contemplative-receptive stage. Increased knowledge will improve relationships between patients/families. Conclusion AHCP increases knowledge about death/dying, reduces anxiety by recognising death as normal aspect of life, increases autonomy for decision-making.

Trends in Engagement in Advance Care Planning Behaviors and the Role of Socioeconomic Status.

We investigated the trends in advance care planning (ACP) between 2002 and 2010 and whether socioeconomic status explained such trends. We conducted a pooled regression analysis of Health and Retirement Study data from 6052 proxies of deceased individuals. We studied 3 ACP behaviors, discussing end-of-life (EOL) care preferences, providing written EOL care instructions, and appointing a durable power of attorney for health care (DPAHC). ACP increased by 12% to 23% every 2 years from 2002 to 2010. Higher household income increased the odds of having a DPAHC. Education was not associated with ACP. Socioeconomic status alone appears to play a very limited role in predicting ACP. Engagement in ACP likely depends on a constellation of many social and contextual factors.

Family Relationships and Advance Care Planning: Do Supportive and Critical Relations Encourage or Hinder Planning?

The effectiveness of advance care planning (ACP) may depend on family members' understanding of patient preferences. However, we know of no studies that explore the association between family relationship dynamics and ACP. ACP includes a living will, durable power of attorney for health care (DPAHC) appointment, and discussions. We evaluated the effects of three aspects of family relations--general family functioning, support and criticism from spouse, and support and criticism from children--on both overall ACP and specific DPAHC designations. Using multinomial logistic regression models and data from a sample of 293 older adults, we estimated the effects of family relationship quality on the likelihood of completing ACP and appointing a spouse or adult child as DPAHC. Analyses controlled for demographic and health characteristics. Better overall family functioning increased the odds of ACP. Higher levels of spousal support increased the odds of holding informal discussions, whereas spousal criticism reduced the odds of naming one's spouse as DPAHC. Both criticism and emotional support from children increased the odds that a child was named as DPAHC. Family dynamics affect ACP in complex ways and should be considered when patients and their families discuss end-of-life care and make DPAHC designations.

Pathways From Religion to Advance Care Planning: Beliefs About Control Over Length of Life and End-of-Life Values

To evaluate the extent to which religious affiliation and self-identified religious importance affect advance care planning (ACP) via beliefs about control over life length and end-of-life values. Three hundred and five adults aged 55 and older from diverse racial and socioeconomic groups seeking outpatient care in New Jersey were surveyed. Measures included discussion of end-of-life preferences; living will (LW) completion; durable power of attorney for healthcare (DPAHC) appointment; religious affiliation; importance of religion; and beliefs about who/what controls life length, end-of-life values, health status, and sociodemographics. Of the sample, 68.9% had an informal discussion and 46.2% both discussed their preferences and did formal ACP (LW and/or DPAHC). Conservative Protestants and those placing great importance on religion/spirituality had a lower likelihood of ACP. These associations were largely accounted for by beliefs about God's controlling life length and values for using all available treatments. Beliefs and values about control account for relationships between religiosity and ACP. Beliefs and some values differ by religious affiliation. As such, congregations may be one nonclinical setting in which ACP discussions could be held, as individuals with similar attitudes toward the end of life could discuss their treatment preferences with those who share their views.

A Geriatrician's Gifts

A Geriatrician's Gifts

Proactive Dementia Care: A Five-Year Experience in Dementia Caregiver Counseling (P07.156)

Objective: To determine whether health educator (HE) and social worker (SW) counseling at time of diagnosis improves compliance with doctor advice related to dementia care. Background The contributions of HE and SW counseling to dementia care are underrecognized. Design/Methods: 1577 patients with a cognitive disorder were seen in a dementia clinic between January 2006 and December, 2010. All patients were referred to a HE and to a SW. We retrospectively determined how often a durable power of attorney for health care (DPOA) was present in the medical record and the enrollment level in our Gift to Life autopsy program (GTL). Results: Patients reflected the typical demographics of a dementia specialty clinic - 682 were men (43.24%), mean age 72.8 (SD 11.04), range 29 – 98 years, education 0 – 20 years, mean 14.25 (SD 2.9), Mini-Mental Status Exam (MMSE) or equivalent 0 – 30, mean 22.08 (SD 6.85). 1167 (74%) met with the health educator at least once, and 353 (22%) met with the social worker. We performed 4 separate logistic regression models with DPOA or GTL enrolment as outcomes, and SW visit (yes/no), or HE visit (yes/no) as predictor and controlled for gender and dichotomized for age, years of education, symptom years, and MMSE using cut off point 70, 12, 2, and 24 respectively. Exposure to either SW or HE was associated with DPOA documentation and enrollment in GTL.outcome Predictor Used observations OR (95% CI) pDPOA HE 1247 1.68 (1.29, 2.19) Conclusions: HE and/or SW counseling increases compliance with physician advice to complete a DPOA and to enroll in GTL. Prospective studies are needed to demonstrate that HE and SW improve quality of life and reduce costs. Supported by: Anonymous donor. A grant from The Center for Health Improvement. The Center for Alzheimer9s Care, Imaging, and Research at the University of Utah. Disclosure: Dr. Zamrini has nothing to disclose. Dr. Mandal has nothing to disclose. Dr. Andersen has nothing to disclose. Dr. Simpson has nothing to disclose. Dr. Wang has nothing to disclose. Dr. Greene has nothing to disclose. Dr. Ying has nothing to disclose. Dr. King has received research support from Alzheimer9s Association and the National Institute on Aging. Dr. Foster has received personal compensation for activities with GE Healthcare and Bristol-Myers Squibb Company. Dr. Foster received research support from Eli Lilly & Company, Janssen Alzheimer Immunotherapy, and Pfizer Inc.

Racial Differences in End-Of-Life Planning: Why Don'T Blacks and Latinos Prepare for the Inevitable?

I evaluate the extent to which ethnic disparities in advance care planning reflect cultural and religious attitudes and experience with the painful deaths of loved ones. Data are from a sample of 293 chronically ill older adults who are seeking care at one of two large medical centers in urban New Jersey. Blacks and Hispanics are significantly less likely than Whites to have a living will, a durable power of attorney for health care (DPAHC), and to have discussed their end of life treatment preferences. Multivariate analyses reveal that the Black-White gap in advance care planning is largely accounted for by Blacks' belief that God controls the timing and nature of death. The Hispanic-White gap is partially accounted for by the belief that one's illness negatively affects one's family. Ethnic disparities are starkest for living will and DPAHC use, and less pronounced for discussions. Implications for policy and practice are discussed.

Acceptors and Rejecters of Life-Sustaining Treatment

Because most patients are decisionally incapacitated at the end of life, health care providers often rely on advance directives or proxies’ substituted judgment for guidance in treatment decisions. In a survey of 202 older adults and their respective proxies, we compared older adults who would reject life-sustaining care to those who would accept it in terms of the availability and accuracy of the information sources that providers would consult, viz., whether the patient had (a) completed a living will, (b) designated a durable power of attorney for health care (DPAHC), and (c) discussed wishes with a proxy; and (d) we calculated the accuracy of proxies’ substituted judgment. Older adults who would accept all treatments were significantly less likely to have completed a living will, assigned a DPAHC, or discussed their wishes with their proxies, and their proxies were much less accurate in understanding their wishes.

The Importance of Feeling Understood in Marital Conversations about End-of-Life Health Care.

This study investigates processes within marital discussions about end-of-life medical treatment preferences. The associations among marital quality, the perception of having been understood following discussion, and intentions for whom to appoint as a health care surrogate are addressed. Data from 2,969 white married couples in their mid-60s are analyzed. Four-fifths of primary respondents reported that their partners understood their preferences extremely well. Primary respondents' perceptions of high marital quality were associated with feeling extremely well understood. In turn, feeling understood partially mediated the relationship between perceptions of marital quality and the intention to appoint the partner as durable power of attorney for health care (DPAHC). Implications for research on marital communication and quality end-of-life health care are discussed.