Four Groups of Advance Care Planning Engagement Among Older People: A Latent Class Analysis

Advance care planning (ACP) enables older people to discuss their preferences for future care with family/friends, with healthcare professionals, and to document their preferences. However, little is known about which combinations of ACP actions commonly co-occur. Understanding such groups can help tailor ACP interventions effectively.

To examine whether meaningful groups exist among older people based on ACP engagement, and to further assess the groups' demographic, health and care-related characteristics, as well as future preferences and concerns.

A cross-sectional study in a nationwide sample of 1242 Dutch older people aged 65 years and older (response rate: 93.2%) was conducted. A Latent Class Analysis was performed using 21 items: three ACP actions (discussions with family/friends, with healthcare professionals, and documentation) across seven topics about place of care and end-of-life decisions. Also, descriptive statistics and chi-square tests were performed.

Four latent classes were identified: 1) Inactive ACP group (60%)-low engagement in ACP; 2) Relatives-oriented (28%)-engagement in discussions with family/friends but limited for healthcare professionals or documentation; 3) Documentation-oriented (7%)-documented end-of-life decisions, but limited to no engagement with family/friends and healthcare professionals; and 4) Comprehensive (5%)- moderate engagement across all actions. Individuals in the comprehensive ACP group more often reported (very) poor health, compared to others. The Inactive ACP group was more often religious and less often highly educated.

ACP engagement among older people is heterogeneous and can be categorized into four distinct groups. Educational interventions are needed to raise awareness and encourage ACP engagement (for specific actions).