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Title: Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services: multicentre audit study.
Austin Authors: Detering, Karen M ;Buck, Kimberly ;Ruseckaite, Rasa;Kelly, Helana;Sellars, Marcus ;Sinclair, Craig;Clayton, Josephine M;Nolte, Linda 
Affiliation: Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia
Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
Centre for Learning and Research in Palliative Care, Hammond Care, Greenwich Hospital and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia
Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
Issue Date: 15-Jan-2019 2019
Publication information: BMJ Open 2019; 9(1): e025255
Abstract: It is important that the outcomes of advance care planning (ACP) conversations are documented and available at the point of care. Advance care directives (ACDs) are a subset of ACP documentation and refer to structured documents that are completed and signed by competent adults. Other ACP documentation includes informal documentation by the person or on behalf of the person by someone else (eg, clinician, family). The primary objectives were to describe the prevalence and correlates of ACDs among Australians aged 65 and over accessing health and residential aged care services. The secondary aim was to describe the prevalence of other ACP documentation. A prospective multicentre health record audit in general practices (n=13), hospitals (n=12) and residential aged care facilities (RACFs; n=26). 503 people attending general practice, 574 people admitted to hospitals and 1208 people in RACFs. Prevalence of one or more ACDs; prevalence of other ACP documentation. 29.8% of people had at least one ACD on file. The majority were non-statutory documents (20.9%). ACD prevalence was significantly higher in RACFs (47.7%) than hospitals (15.7%) and general practices (3.2%) (p<0.001), and varied across jurisdictions. Multivariate logistic regression showed that the odds of having an ACD were positively associated with greater functional impairment and being in an RACF or hospital compared with general practice. 21.6% of people had other ACP documentation. In this study, 30% of people had ACDs accessible and a further 20% had other ACP documentation, suggesting that approximately half of participants had some form of ACP. Correlates of ACD completion were greater impairment and being in an RACF or hospital. Greater efforts to promote and standardise ACDs across jurisdictions may help to assist older people to navigate and complete ACDs and to receive care consistent with their preferences. ACTRN12617000743369.
DOI: 10.1136/bmjopen-2018-025255
ORCID: 0000-0002-8299-0313
Journal: BMJ Open
PubMed URL: 30647047
Type: Journal Article
Subjects: advance care directive
advance care planning
clinical audit
quality in health care
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