Advance Care Planning in Nursing Homes: Correlates of Capacity and Possession of Advance Directives

Autor/inn/en	Allen, Rebecca S.; DeLaine, Shermetra R.; Chaplin, William F.; Marson, Daniel C.; Bourgeois, Michelle S.; Dijkstra, Katinka; Burgio, Louis D.
Titel	Advance Care Planning in Nursing Homes: Correlates of Capacity and Possession of Advance Directives
Quelle	In: Gerontologist, 43 (2003) 3, S.309-317 (9 Seiten) PDF als Volltext Verfügbarkeit
Sprache	englisch
Dokumenttyp	gedruckt; online; Zeitschriftenaufsatz
ISSN	0016-9013
Schlagwörter	Medical Services; Verbal Communication; Dementia; Interaction; Nursing Homes; Verbal Ability; Cognitive Ability; Ethics; Older Adults; Evaluation Methods; Residential Care; Decision Making Skills; Observation; Long Range Planning; Identification + Suchen Sie Ihr Suchwort? Arzt; Demenz; Interaktion; Sonderheim; Mündliche Leistung; Denkfähigkeit; Ethik; Älterer Erwachsener; Beobachtung; Langfristige Planung; Identifikation; Identifizierung
Abstract	Purpose: The identification of nursing home residents who can continue to participate in advance care planning about end-of-life care is a critical clinical and bioethical issue. This study uses high quality observational research to identify correlates of advance care planning in nursing homes, including objective measurement of capacity. Design and Methods: The authors used cross-sectional, cohort study between 1997 and 1999. Seventy-eight residents (M age = 83.97, SD = 8.2) and their proxies (M age = 59.23, SD = 11.77) were included across five nursing homes. The authors obtained data via chart review, proxy interviews, resident assessments, survey completion by certified nursing assistants, and direct observation of residents' daily behaviors. Results: Capacity assessments revealed that most residents could state a simple treatment preference (82.4%), but a sizable number did not retain capacity to understand treatment alternatives or appreciate the consequences of their choice. Global cognitive ability (Mini-Mental State Examination score) was related to understanding and appreciation. When the authors removed the effects of global cognitive ability, understanding and appreciation were related to time spent by residents in verbal interaction with others. Residents were more likely to possess advance directives when proxies possessed advance directives, proxies were less religious, and residents were socially engaged. Implications: Assessment of proxy beliefs and direct determination of residents' decisional capacity and social engagement may help nursing home staff identify families who may participate in advance planning for end-of-life medical care. Measures of global cognitive ability offer limited information about resident capacity for decision making. Decisional capacity assessments should enhance the verbal ability of individuals with dementia by reducing reliance on memory in the assessment process. Interventions to engage residents and families in structured discussions for end-of-life planning are needed. (As Provided).
Anmerkungen	Gerontological Society of America. 1030 15th Street NW Suite 250, Washington, DC 20005. Tel: 202-842-1275; Fax: 202-842-1150; e-mail: geron@geron.org; Web site: http://www.geron.org/journals/gsapub.htm
Erfasst von	ERIC (Education Resources Information Center), Washington, DC
Update	2017/4/10