02 Nov Minorities Much Less Likely To Have Advance Care Health Planning
MedicalResearch.com Interview with:
Krista Lyn Harrison, PhD
Division of Geriatrics School of Medicine
University of California
San Francisco VA Medical Center
San Francisco, CA 94121
MedicalResearch.com: What is the background for this study?
Response: Advance care planning (ACP) is the process of discussing plans and preferences for end-of-life care. It may include completion of advanced directives or a living will and designation of a surrogate decision-maker in a durable power of attorney for health care. There is a growing awareness of the benefits of such discussions for both elders and their families. In absence of these discussions, loved ones are left to guess what the affected individual wanted or may even get mired in unexpected legal issues. But until recently, it was unknown if all races/ethnicities, education levels, and incomes have benefited from efforts to improve engagement in advance care planning, and if these discussions are greater among those in worse health and with a poorer prognosis.
MedicalResearch.com: What are the main findings?
Response: More than one in four older adults have not engaged in planning for end-of-life care or directives. This is especially true for African Americans, Latinos and those with less education and income.
Older Spanish-speaking Latinos had the lowest reported engagement in advance care planning of any group, with 19 percent reporting end-of-life discussion, 20 percent durable power of attorney and 17 percent advanced directives.
Although we expected to see that individuals in worse health had higher rates of engaging in ACP, there was little to no increase in discussions among older adults with multiple areas of morbidity or disability in activities of daily living. Older adults with dementia had significantly lower prevalence of end-of-life discussions (54 percent) and advance directives (46 percent) compared to those with no dementia (62 percent and 54 percent, respectively).
MedicalResearch.com: What should readers take away from your report?
Response: Our findings suggest that there are substantial portions of the population of community-dwelling older adults who need to begin discussions about their plans and preferences before they are unable to share those preferences with their loved ones.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: First, we need to better understand what is driving disparities by sociodemographic and health-related factors. For example, are they caused by clinicians inadequately engaging older adults in culturally-appropriate and proactive ways?.
Second, we need to examine the combined impact of new interventions and policies on disparities in advance care planning. In 2016, the Centers for Medicaid Services began reimbursing physicians for engaging Medicare beneficiaries in advance care planning. During these conversations, physicians can use communication strategies that are being developed and tested for the specific needs of minorities and older adults with multimorbidity and dementia.
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Harrison KL, Adrion ER, Ritchie CS, Sudore RL, Smith AK. Low Completion and Disparities in Advance Care Planning Activities Among Older Medicare Beneficiaries. JAMA Intern Med. Published online October 31, 2016. doi:10.1001/jamainternmed.2016.6751
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