Advance care planning among the oldest old

Area of Science:

• Gerontology
• Palliative Care
• Health Services Research

Background:

• Advance care planning (ACP) is crucial for end-of-life decision-making, particularly for the oldest-old (≥85 years).
• Documentation of care preferences and surrogates is essential but often lacking in this vulnerable population.

Purpose of the Study:

• To describe the prevalence of end-of-life advance care planning documentation among the oldest-old veterans.
• To identify patient characteristics and healthcare utilization patterns associated with ACP documentation.

Main Methods:

• Medical charts of 175 veterans aged ≥85 who died between 1999-2000 were reviewed.
• Data on advance care planning, surrogates, demographics, clinical factors, and healthcare utilization were collected.
• Multivariate logistic regression modeled associations with ACP documentation.

Main Results:

• Only 34% of available records showed documented care preferences, and 46% documented surrogates.
• Older age and higher frequency of outpatient visits (general/geriatric medicine) were associated with advance directive completion.
• Similar associations were found for surrogate documentation, with outpatient visits being a key factor.

Conclusions:

• Advance care planning documentation remains infrequent even in high-quality care systems for the oldest-old.
• Increased engagement with outpatient primary care and geriatric providers may enhance end-of-life care planning and documentation.