CHARACTERIZING THE USE AND DOCUMENTATION OF ADVANCED DIRECTIVES IN FOUR DIVERSE ASSISTED LIVING FACILITIES. (16th November 2018)

• Record Type: Journal Article
• Authors: Coyle, M; Perkins, M; Robert, M; Quest, T; Bender, A
• Is Part Of: Innovation in aging. Volume 2(2018)Supplement 1
• Page Start: 920
• Page End: 920
• Publication Date: 2018-11-16
• Subjects: Aging -- Periodicals; Gerontology -- Periodicals; 612.67
• DOI: 10.1093/geroni/igy031.3422
• Languages: English
• ISSNs: 2399-5300

Abstract

Abstract: Advance directives (AD) are intended to help facilitate end-of-life (EOL) wishes of people and decrease decisional burden on family members. Completion of an AD has been shown to result in reduced hospitalizations and use of life-sustaining treatment and increased utilization of hospice or palliative care services at EOL. Despite an increasing number of older adults living and dying in assisted living (AL), there is limited research examining AD documentation in this setting. As part of a larger study investigating best practices for palliative and end-of-life care in AL funded by the National Institute on Aging (1R01AG017408-01A1), we reviewed facility health records 70 residents across four diverse AL facilities. Descriptive statistics were used to characterize AD use and documentation. Of these 70 residents, the majority (64%) did not have any form of AD on file, including 6 on hospice. The average age of residents in the sample was 86, most were female (66%), white (57%), and had at least a high school education (75%). The average score on the Montreal Cognitive Assessment (MoCA) was 16 out of 30, indicating moderate levels of cognitive impairment. Considering the advanced age and declining health of this population, the lack of AD documentation has serious implications for delivery of quality care at EOL. This descriptive study examines the individual-level (e.g., sociodemographic and health characteristics) and facility-level (e.g., resident profile and facility policies) factors associated with documentation of AD in these four diverse AL facilities and provides recommendations for increasing use of ADs in these settings.