1. Advance Care Planning in Frail Older Adults: A Cluster Randomized Controlled Trial.
- Author
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Overbeek A, Korfage IJ, Jabbarian LJ, Billekens P, Hammes BJ, Polinder S, Severijnen J, Swart SJ, Witkamp FE, van der Heide A, and Rietjens JAC
- Subjects
- Aged, Aged, 80 and over, Decision Making, Female, Geriatric Assessment, Homes for the Aged statistics & numerical data, Humans, Independent Living psychology, Independent Living statistics & numerical data, Male, Netherlands, Outcome Assessment, Health Care, Patient Participation psychology, Patient Participation statistics & numerical data, Patient-Centered Care, Advance Care Planning organization & administration, Advance Directives psychology, Advance Directives statistics & numerical data, Frail Elderly psychology, Frail Elderly statistics & numerical data, Patient Participation methods, Quality of Life
- Abstract
Objectives: To determine the effectiveness of advance care planning (ACP) in frail older adults., Design: Cluster randomized controlled trial., Setting: Residential care homes in the Netherlands (N=16)., Participants: Care home residents and community-dwelling adults receiving home care (N=201; n=101 intervention; n=100 control). Participants were 75 years and older, frail, and capable of consenting to participation., Intervention: Adjusted Respecting Choices ACP program., Measurements: The primary outcome was change in patient activation (Patient Activation Measure, PAM-13) between baseline and 12-month follow-up. Secondary outcomes included change in quality of life (SF-12), advance directive (AD) completion, and surrogate decision-maker appointment. Use of medical care in the 12 months after inclusion was also assessed. Multilevel analyses were performed, controlling for clustering effects and differences in demographics., Results: Seventy-seven intervention participants and 83 controls completed the follow-up assessment. There were no statistically significant differences between the intervention (-0.26±11.2) and control group (-1.43±10.6) in change scores of the PAM (p=.43) or the SF-12. Of intervention group participants, 93% completed an AD, and 94% appointed a decision-maker. Of control participants, 34% completed an AD, and 67% appointed a decision-maker (p<.001). No differences in the use of medical care were found., Conclusions: ACP did not increase levels of patient activation or quality of life but did increase completion of ADs and appointment of surrogate decision-makers. It did not affect use of medical care., (© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.)
- Published
- 2018
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