Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services: Multicentre audit study

Karen M. Detering, Kimberly Buck, Rasa Ruseckaite, Helana Kelly, Marcus Sellars, Craig Sinclair, Josephine M. Clayton, Linda Nolte

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives: 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. Design and setting: A prospective multicentre health record audit in general practices (n=13), hospitals (n=12) and residential aged care facilities (RACFs; n=26). Participants: 503 people attending general practice, 574 people admitted to hospitals and 1208 people in RACFs. Primary and secondary outcome measures: Prevalence of one or more ACDs; prevalence of other ACP documentation. Results: 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. Conclusions: 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.

Original languageEnglish
Article numbere025255
JournalBMJ Open
Volume9
Issue number1
DOIs
Publication statusPublished - 1 Jan 2019

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Advance Directives
Advance Care Planning
Multicenter Studies
Documentation
Health
General Practice
Point-of-Care Systems
Logistic Models
Outcome Assessment (Health Care)

Cite this

Detering, Karen M. ; Buck, Kimberly ; Ruseckaite, Rasa ; Kelly, Helana ; Sellars, Marcus ; Sinclair, Craig ; Clayton, Josephine M. ; Nolte, Linda. / Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services : Multicentre audit study. In: BMJ Open. 2019 ; Vol. 9, No. 1.
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Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services : Multicentre audit study. / Detering, Karen M.; Buck, Kimberly; Ruseckaite, Rasa; Kelly, Helana; Sellars, Marcus; Sinclair, Craig; Clayton, Josephine M.; Nolte, Linda.

In: BMJ Open, Vol. 9, No. 1, e025255, 01.01.2019.

Research output: Contribution to journalArticle

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T1 - Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services

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AU - Detering, Karen M.

AU - Buck, Kimberly

AU - Ruseckaite, Rasa

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KW - quality in health care

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