Hostname: page-component-5c6d5d7d68-7tdvq Total loading time: 0 Render date: 2024-08-15T08:17:53.831Z Has data issue: false hasContentIssue false
  • English
  • Français

Unmarried patients with early cognitive impairment are more likely than their married counterparts to complete advance care plans

Published online by Cambridge University Press:  23 November 2016

Tong Jen Lo ,
Ngoc Huong Lien Ha ,
Chong Jin Ng ,
Gabriel Tan ,
Hui Mien Koh  and
Philip Lin Kiat Yap
Tong Jen Lo
Affiliation:
Geriatric Centre, Khoo Teck Puat Hospital, Alexandra Health System, 90 Yishun Central, Singapore, 768828, Singapore National Cancer Centre, 11 Hospital Drive, Singapore, 169610, Singapore
Ngoc Huong Lien Ha
Affiliation:
Geriatric Centre, Khoo Teck Puat Hospital, Alexandra Health System, 90 Yishun Central, Singapore, 768828, Singapore Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
Chong Jin Ng
Affiliation:
Geriatric Centre, Khoo Teck Puat Hospital, Alexandra Health System, 90 Yishun Central, Singapore, 768828, Singapore
Gabriel Tan
Affiliation:
Ministry of Health Holdings, 1 Maritime Square, Singapore, 099253, Singapore
Hui Mien Koh
Affiliation:
Geriatric Centre, Khoo Teck Puat Hospital, Alexandra Health System, 90 Yishun Central, Singapore, 768828, Singapore
Philip Lin Kiat Yap*
Affiliation:
Geriatric Centre, Khoo Teck Puat Hospital, Alexandra Health System, 90 Yishun Central, Singapore, 768828, Singapore Geriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore
*
Correspondence should be addressed to: A/Prof Yap Lin Kiat Philip, Senior Consultant Geriatrician, Department of Geriatric Medicine, 90 Yishun Central, Khoo Teck Puat Hospital, Alexandra Health System, Singapore 768828. Phone: 65-66022154. Email: yap.philip.lk@alexandrahealth.com.sg.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Patients with early cognitive impairment (ECI) face the prospect of progressive cognitive decline that impairs their ability to make decisions on financial and personal matters. Advance care planning (ACP) is a process that facilitates decision making on future care and often includes identifying a proxy decision maker. This prospective study explores factors related to completion or non-completion of ACP in patients with ECI.

Methods:

Patients with ECI (n = 158, Mage = 76.2 ± 7.25 years) at a memory clinic received psycho-education and counseling on the importance of ACP and followed-up longitudinally for up to 12 months to ascertain if ACP had been completed. Univariate and logistic regression were used to analyze factors related to completion and non-completion of ACP.

Results:

Seventy-seven patients (48.7%) were initially willing to consider ACP after the counseling and psycho-educational session but only 17 (11.0%) eventually completed ACP. On logistic regression, patients who were single were 8.9 times more likely to complete ACP than those who were married (p = 0.007). Among those initially willing to consider ACP, factors impeding completion of ACP included patient (48.0%), process (31.0%), and family factors (21.0%).

Conclusions:

As unmarried patients may not have immediate family members to depend on to make decisions, they may perceive ACP to be more important and relevant. Understanding the barriers to ACP completion can facilitate targeted interventions to improve the uptake of ACP.

Keywords

advance care planninglasting power of attorneyearly cognitive impairmentcompletionnon-completionperson-centered care
Type
Research Article
Information
International Psychogeriatrics , Volume 29 , Issue 3 , March 2017 , pp. 509 - 516
Copyright
Copyright © International Psychogeriatric Association 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association, D. S. M. T. F., & American Psychiatric, A. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5 (Vol. 5th). Washington, DC: American Psychiatric Publishing.Google Scholar
Burgener, S. C., Yang, Y., Gilbert, R. and Marsh-Yant, S. (2008). The effects of a multimodal intervention on outcomes of persons with early-stage dementia. American Journal of Alzheimers Disease and Other Dementias, 23, 382–394. doi: 10.1177/1533317508317527.Google Scholar
Campos, B., Ullman, J. B., Aguilera, A. and Dunkel Schetter, C. (2014). Familism and psychological health: the intervening role of closeness and social support. Cultural Diversity and Ethnic Minority Psychology, 20, 191–201. doi: 10.1037/a0034094.Google Scholar
Cheong, K., Fisher, P., Goh, J., Ng, L., Koh, H. M. and Yap, P. (2015). Advance care planning in people with early cognitive impairment. BMJ Supportive & Palliative Care, 5, 63–69. doi: 10.1136/bmjspcare-2014-000648.Google Scholar
Fagerlin, A. and Schneider, C. E. (2004). Enough: the failure of the living will. Hastings Center Report, 34, 30–42. doi: 10.2307/3527683.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Fournier, V., Berthiau, D., Kempf, E. and d'Haussy, J. (2013). Quelle utilité des directives anticipées pour les médecins? La Presse Médicale, 42, e159–e169. doi: http://dx.doi.org/10.1016/j.lpm.2012.09.027.CrossRefGoogle Scholar
Garand, L., Dew, M. A., Lingler, J. H. and DeKosky, S. T. (2011). Incidence and predictors of advance care planning among persons with cognitive impairment. The American Journal of Geriatric Psychiatry, 19, 712–720. doi: 10.1097/JGP.0b013e3181faebef.Google Scholar
Hirschman, K. B., Kapo, J. M. and Karlawish, J. H. T. (2008). Identifying the factors that facilitate or hinder advance planning by persons with dementia. Alzheimer disease and associated disorders, 22, 293–298. doi: 10.1097/WAD.0b013e318169d669.Google Scholar
Lee, T. J. (2014). Discussing advance care planning with elderly patients. North Carolina medical journal, 75, 347.Google Scholar
Morris, J. C. (1993). The clinical dementia rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414.Google Scholar
Robinson, L. et al. (2012). A systematic review of the effectiveness of advance care planning interventions for people with cognitive impairment and dementia. Age Ageing, 41, 263–269. doi: 10.1093/ageing/afr148.Google Scholar
Sampson, E. L. et al. (2011). Palliative assessment and advance care planning in severe dementia: an exploratory randomized controlled trial of a complex intervention. Palliative Medicine, 25, 197–209. doi: 10.1177/0269216310391691.Google Scholar
Smebye, K. L., Kirkevold, M. and Engedal, K. (2012). How do persons with dementia participate in decision making related to health and daily care? a multi-case study. BMC health services research, 12, 241–241. doi: 10.1186/1472-6963-12-241.CrossRefGoogle Scholar
Sorrell, J. M. (2013). Diagnostic and Statistical Manual of Mental Disorders-5: implications for older adults and their families. Journal of Psychosocial Nursing and Mental Health Services, 51, 19–22. doi: 10.3928/02793695-20130207-01.Google Scholar
Spranzi, M. and Fournier, V. (2016). The near-failure of advance directives: why they should not be abandoned altogether, but their role radically reconsidered. Medicine, Health Care and Philosophy, 1–6. doi: 10.1007/s11019-016-9704-7.Google Scholar
Tay, S. Y., Davison, J., Jin, N. C. and Yap, P. L. (2015). Education and executive function mediate engagement in advance care planning in early cognitive impairment. Journal of the American Medical Directors, 16, 957–962. doi: 10.1016/j.jamda.2015.05.014.Google Scholar
Triplett, P. et al. (2008). Content of advance directives for individuals with advanced dementia. Journal of Aging and Health, 20, 583–596. doi: 10.1177/0898264308317822.Google Scholar
van der Steen, J. T. et al. (2014). Factors associated with initiation of advance care planning in dementia: a systematic review. Journal of Alzheimer's Disease: JAD, 40, 743–757. doi: 10.3233/jad-131967.Google Scholar
Verhey, F. R. J., Rozendaal, N., Ponds, R. W. H. M. and Jolles, J. (1993). Dementia, awareness and depression. International Journal of Geriatric Psychiatry, 8, 851–856. doi: 10.1002/gps.930081008.Google Scholar
Winblad, B. et al. (2004). Mild cognitive impairment – beyond controversies, towards a consensus: report of the international working group on mild cognitive impairment. Journal of Internal Medicine, 256, 240–246. doi: 10.1111/j.1365-2796.2004.01380.x.Google Scholar