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Advance Care Planning Prior to Death in Older Adults with Hip Fracture.

Abstract：

BACKGROUND:Although hip fractures in older adults are associated with a high degree of mortality and disability, the use of advance care planning (ACP) in this population is unknown. OBJECTIVE:To determine the prevalence of ACP and need for surrogate decision-making prior to death in older adults with hip fracture and to identify factors associated with ACP. DESIGN:Retrospective cohort study using Health and Retirement Study (HRS) interviews linked to Medicare fee-for-service claims data. PARTICIPANTS:Six hundred six decedent participants aged 65 or older who sustained a hip fracture during HRS enrollment and had a proxy participate in the exit HRS survey. MAIN MEASURES:Survey responses by proxies were used to determine ACP, defined by either advance directive completion or surrogate designation, and to assess decision-making at the end of life. Multivariate logistic regression was used to analyze correlates of ACP. KEY RESULTS:Prior to death, 54.9% of all participants had an advance directive and 68.9% had designated a surrogate decision-maker; however, 24.5% had no ACP. Of the total cohort, 32.5% required decisions to be made about treatment at the end of life and lacked capacity to make these decisions themselves. In this subset, 19.9% had no ACP. In all participants, ACP was less likely in non-white individuals (adjusted odds ratio (aOR) 0.14, 95% CI 0.06-0.31), those with less than a high school education (aOR 0.58, 95% CI 0.35-0.97), and those with a net worth below the median of the cohort (aOR 0.49, 95% CI 0.26-0.72). No clinical factors were found to be associated with ACP completion prior to death. CONCLUSIONS:A considerable number of older adults with hip fracture required surrogate decision-making at the end of life, of whom one fifth had no ACP prior to death. Clinicians providing care for these patients are uniquely poised to address ACP.

journal_name

J Gen Intern Med

journal_title

Journal of general internal medicine

authors

Kata A,Cenzer I,Sudore RL,Covinsky KE,Tang VL

doi

10.1007/s11606-020-05644-1

subject

Has Abstract

pub_date

2020-07-01 00:00:00

pages

1946-1953

issue

eissn

0884-8734

issn

1525-1497

pii

10.1007/s11606-020-05644-1

journal_volume

pub_type

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Advance Care Planning Prior to Death in Older Adults with Hip Fracture.