Advance directives and power of attorney for health care in the oldest-old – results of the AgeQualiDe study

BMC Geriatrics

Research Article

Jochen Werle¹  Siegfried Weyerer¹  Hans-Helmut Koenig²  Christian Brettschneider²  Martin Scherer³  Tina Mallon³  Carolin van der Leeden³  Dagmar Weeg⁴  Horst Bickel⁴  Kathrin Heser⁵  Michael Wagner⁶  Wolfgang Maier⁶  Angela Fuchs⁷  Jürgen in der Schmitten⁷  Tobias Luck⁸  Steffi G. Riedel-Heller⁸  Francisca S. Rodriguez⁹  Birgitt Wiese^1,10  Silke Mamone^1,10 

[1] Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany;Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;Department of Psychiatry, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany;Department of Psychiatry, University of Bonn, Bonn, Germany;Department of Psychiatry, University of Bonn, Bonn, Germany;DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany;Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany;Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany;Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany;LIFE – Leipzig Research Center for Civilization Diseases, Universität Leipzig, Leipzig, Germany;Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, USA;Work Group Medical Statistics and IT-Infrastructure, Institute for General Practice, Hannover Medical School, Hannover, Germany;

关键词: Oldest-old age;    Prevalence;    Frequency;    Primary care;    Power of attorney;    Advance directives;    Advance care planning;   

DOI  :  10.1186/s12877-017-0482-8

 received in 2016-08-02, accepted in 2017-04-06,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundCompletion of advance directives (ADs) and power of attorney (POA) documents may protect a person’s autonomy in future health care situations when the individual lacks decisional capacity. As such situations become naturally much more common in old age, we specifically aimed at providing information on (i) the frequency of ADs/POA in oldest-old individuals and (ii) factors associated with having completed ADs/POA.MethodsWe analyzed data of oldest-old primary care patients (85+ years; including community-dwelling and institutionalized individuals) within the German AgeQualiDe study. Patients were initially recruited via their general practitioners (GPs). We calculated frequencies of ADs and POA for health care with 95% confidence intervals (CI) and used multivariable logistic regression analysis to evaluate the association between having ADs and POA and participants’ socio-demographic, cognitive, functional, and health-related characteristics.ResultsAmong 868 GP patients participating in AgeQualiDe (response = 90.9%), n = 161 had dementia and n = 3 were too exhausted/ill to answer the questions. Out of the remaining 704 (81.1%) dementia-free patients (mean age = 88.7 years; SD = 3.0), 69.0% (95%-CI = 65.6–72.4) stated to having ADs and 64.6% (95%-CI = 61.1–68.2) to having a POA for health care. Individual characteristics did not explain much of the variability of the presence/absence of ADs and POA (regression models: Nagelkerke’s R2 = 0.034/0.051). The most frequently stated reasons for not having ADs were that the older adults trust their relatives or physicians to make the right decisions for them when necessary (stated by 59.4% and 44.8% of those without ADs). Among the older adults with ADs, the majority had received assistance in its preparation (79.0%), most frequently from their children/grandchildren (38.3%). Children/grandchildren were also the most frequently stated group of designated persons (76.7%) for those with a POA for health care.ConclusionsOur findings suggest a high dissemination of ADs and POA for health care in the oldest-old in Germany. Some adults without ADs/POA perhaps would have completed advance care documents, if they had had received more information and support. When planning programs to offer advanced care planning to the oldest old, it might be helpful to respond to these specific needs, and also to be sensitive to attitudinal differences in this target group.

【 授权许可】

CC BY   
© The Author(s). 2017