Advance directives and power of attorney for health care in the oldest-old – results of the AgeQualiDe study
Abstract Background Completion 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 p...
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| Format: | Article |
| Language: | English |
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BMC
2017-04-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12877-017-0482-8 |
| _version_ | 1828861689414549504 |
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| author | Tobias Luck Francisca S. Rodriguez Birgitt Wiese Carolin van der Leeden Kathrin Heser Horst Bickel Jürgen in der Schmitten Hans-Helmut Koenig Siegfried Weyerer Silke Mamone Tina Mallon Michael Wagner Dagmar Weeg Angela Fuchs Christian Brettschneider Jochen Werle Martin Scherer Wolfgang Maier Steffi G. Riedel-Heller for the AgeCoDe & AgeQualiDe study group |
| author_facet | Tobias Luck Francisca S. Rodriguez Birgitt Wiese Carolin van der Leeden Kathrin Heser Horst Bickel Jürgen in der Schmitten Hans-Helmut Koenig Siegfried Weyerer Silke Mamone Tina Mallon Michael Wagner Dagmar Weeg Angela Fuchs Christian Brettschneider Jochen Werle Martin Scherer Wolfgang Maier Steffi G. Riedel-Heller for the AgeCoDe & AgeQualiDe study group |
| author_sort | Tobias Luck |
| collection | DOAJ |
| description | Abstract Background Completion 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. Methods We 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. Results Among 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. Conclusions Our 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. |
| first_indexed | 2024-12-13T03:06:41Z |
| format | Article |
| id | doaj.art-818ee6b044cd4583a0d0c8cec33ece21 |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-12-13T03:06:41Z |
| publishDate | 2017-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-818ee6b044cd4583a0d0c8cec33ece212022-12-22T00:01:41ZengBMCBMC Geriatrics1471-23182017-04-0117111210.1186/s12877-017-0482-8Advance directives and power of attorney for health care in the oldest-old – results of the AgeQualiDe studyTobias Luck0Francisca S. Rodriguez1Birgitt Wiese2Carolin van der Leeden3Kathrin Heser4Horst Bickel5Jürgen in der Schmitten6Hans-Helmut Koenig7Siegfried Weyerer8Silke Mamone9Tina Mallon10Michael Wagner11Dagmar Weeg12Angela Fuchs13Christian Brettschneider14Jochen Werle15Martin Scherer16Wolfgang Maier17Steffi G. Riedel-Heller18for the AgeCoDe & AgeQualiDe study groupInstitute of Social Medicine, Occupational Health and Public Health (ISAP), University of LeipzigInstitute of Social Medicine, Occupational Health and Public Health (ISAP), University of LeipzigWork Group Medical Statistics and IT-Infrastructure, Institute for General Practice, Hannover Medical SchoolDepartment of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-EppendorfDepartment of Psychiatry, University of BonnDepartment of Psychiatry, Klinikum rechts der Isar, Technical University of MunichInstitute of General Practice, Medical Faculty, Heinrich-Heine-University DüsseldorfDepartment of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-EppendorfCentral Institute of Mental Health, Medical Faculty Mannheim/Heidelberg UniversityWork Group Medical Statistics and IT-Infrastructure, Institute for General Practice, Hannover Medical SchoolDepartment of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-EppendorfDepartment of Psychiatry, University of BonnDepartment of Psychiatry, Klinikum rechts der Isar, Technical University of MunichInstitute of General Practice, Medical Faculty, Heinrich-Heine-University DüsseldorfDepartment of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-EppendorfCentral Institute of Mental Health, Medical Faculty Mannheim/Heidelberg UniversityDepartment of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-EppendorfDepartment of Psychiatry, University of BonnInstitute of Social Medicine, Occupational Health and Public Health (ISAP), University of LeipzigAbstract Background Completion 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. Methods We 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. Results Among 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. Conclusions Our 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.http://link.springer.com/article/10.1186/s12877-017-0482-8Oldest-old agePrevalenceFrequencyPrimary carePower of attorneyAdvance directives |
| spellingShingle | Tobias Luck Francisca S. Rodriguez Birgitt Wiese Carolin van der Leeden Kathrin Heser Horst Bickel Jürgen in der Schmitten Hans-Helmut Koenig Siegfried Weyerer Silke Mamone Tina Mallon Michael Wagner Dagmar Weeg Angela Fuchs Christian Brettschneider Jochen Werle Martin Scherer Wolfgang Maier Steffi G. Riedel-Heller for the AgeCoDe & AgeQualiDe study group Advance directives and power of attorney for health care in the oldest-old – results of the AgeQualiDe study BMC Geriatrics Oldest-old age Prevalence Frequency Primary care Power of attorney Advance directives |
| title | Advance directives and power of attorney for health care in the oldest-old – results of the AgeQualiDe study |
| title_full | Advance directives and power of attorney for health care in the oldest-old – results of the AgeQualiDe study |
| title_fullStr | Advance directives and power of attorney for health care in the oldest-old – results of the AgeQualiDe study |
| title_full_unstemmed | Advance directives and power of attorney for health care in the oldest-old – results of the AgeQualiDe study |
| title_short | Advance directives and power of attorney for health care in the oldest-old – results of the AgeQualiDe study |
| title_sort | advance directives and power of attorney for health care in the oldest old results of the agequalide study |
| topic | Oldest-old age Prevalence Frequency Primary care Power of attorney Advance directives |
| url | http://link.springer.com/article/10.1186/s12877-017-0482-8 |
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