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Cognitive Profile, Social Determinants, and Advance Care Planning: Evidence From the Health and Retirement Study
Zahra Rahemi1, Juanita-Dawne R Bacsu, Delaram Sirizi
1Author Affiliations: School of Nursing, Clemson University, Clemson, South Carolina (Dr Rahemi); School of Nursing, Thompson Rivers University, Kamloops, Canada (Dr Bacsu); Department of Biological, Environmental, and Earth Sciences, University of South Carolina Aiken, Aiken, South Carolina (Dr Sirizi); College of Behavioral, Social, and Health Sciences; School of Nursing, Clemson University, Clemson, South Carolina (Ms Hummel); Marquette University School of Dentistry, Milwaukee, Wisconsin (Dr Omidi); Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy, Texas A&M University, Kingsville & College Station, Texas (Dr Zanwar); Indiana University, Bloomington School of Public Health, Bloomington, Indiana (Dr Smith); and College of Nursing and the Department of Epidemiology & Biostatistics, University of South Carolina, Columbia, South Carolina (Dr Adams).
Background:
Advance care planning (ACP) is important for older adults experiencing cognitive decline, and social determinants of health (SDoH) may shape engagement.
Purpose:
To evaluate cognitive and social-contextual differences in ACP among older adults.
Methods:
Using 2018 Health and Retirement Study data, we evaluated ACP completion, defined as a living will (LW), durable power of attorney for health care, or both, across cognitive status groups and tested SDoH moderation.
Results:
Individuals with dementia or impaired cognition had lower ACP completion than those with normal cognition. Education and neighborhood support moderated cognition-ACP associations. Among less educated individuals, dementia was associated with lower odds of LW completion. Lower neighborhood support was associated with lower odds of LW completion, whereas higher support was associated with greater odds of reporting at least one ACP measure.
Conclusion:
SDoH shape ACP during cognitive decline. Nurses should prioritize early, equitable ACP discussions to improve end-of-life care quality.
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