Association Between Subjective Remaining Life Expectancy and Advance Care Planning in Older Adults: A Cross-Sectional Study

N. Fleuren; M.F.I.A. Depla; H.R.W. Pasman; D.J.A. Janssen; B.D. Onwuteaka-Philipsen; C.M.P.M. Hertogh; M. Huisman

doi:10.1016/j.jpainsymman.2021.02.019

Association Between Subjective Remaining Life Expectancy and Advance Care Planning in Older Adults: A Cross-Sectional Study

N. Fleuren^*, M.F.I.A. Depla, H.R.W. Pasman, D.J.A. Janssen, B.D. Onwuteaka-Philipsen, C.M.P.M. Hertogh, M. Huisman

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Context. Advance care planning (ACP) becomes more relevant with deteriorating health or increasing age. People might be more inclined to engage in ACP as they feel that they are approaching end of life. The perception of approaching end of life could be quantified as subjective remaining life expectancy (SRLE). Objectives. First, to describe the prevalence of ACP with health care providers or written directives ("formal engagement in ACP") and ACP with loved-ones ("informal engagement in ACP") among older persons in the general population in The Netherlands. Second, to assess the association between SRLE and engagement in ACP. Methods. Cross-sectional study using data from the Longitudinal Aging Study Amsterdam (LASA) measurement wave of 2015-2016. Participants (n = 1585) were aged > 57 years. Results. Median age was 69.4 years (IQR: 64.1-76.7), and median SRLE 25.9 years (17.7-36.0). Formal engagement in ACP was present in 32.6%, informal without formal engagement in 45.8%, and 21.6% was not engaged in ACP. For respondents with SRLE < 25 years, there was a nonstatistically significant association between SRLE and engagement in ACP (aOR: 0.97; 95% CI: 0.93-1.01; P= .088), and a statistically significant, small association with formal vs. informal engagement in ACP (aOR: 0.96; 0.93-0.99; P= .009). For respondents with SRLE > 25 years there was no association between SRLE and engagement in ACP. Conclusion. The perception of approaching end of life is associated with higher prevalence of formal engagement in ACP, but only for those with SRLE < 25 years. For clinicians, asking patients after their SRLE might serve as a starting point to explore readiness for ACP. J Pain Symptom Manage 2021;62:757-767. (c) 2021 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Original language	English
Pages (from-to)	757-767
Number of pages	11
Journal	Journal of Pain and Symptom Management
Volume	62
Issue number	4
DOIs	https://doi.org/10.1016/j.jpainsymman.2021.02.019
Publication status	Published - 1 Oct 2021

Keywords

Advance care planning
life expectancy
goals of care
decision making
patient preferences
DEFINITION
CANCER

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10.1016/j.jpainsymman.2021.02.019Licence: CC BY

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Fleuren, N., Depla, M. F. I. A., Pasman, H. R. W., Janssen, D. J. A., Onwuteaka-Philipsen, B. D., Hertogh, C. M. P. M., & Huisman, M. (2021). Association Between Subjective Remaining Life Expectancy and Advance Care Planning in Older Adults: A Cross-Sectional Study. Journal of Pain and Symptom Management, 62(4), 757-767. https://doi.org/10.1016/j.jpainsymman.2021.02.019

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abstract = "Context. Advance care planning (ACP) becomes more relevant with deteriorating health or increasing age. People might be more inclined to engage in ACP as they feel that they are approaching end of life. The perception of approaching end of life could be quantified as subjective remaining life expectancy (SRLE). Objectives. First, to describe the prevalence of ACP with health care providers or written directives ({"}formal engagement in ACP{"}) and ACP with loved-ones ({"}informal engagement in ACP{"}) among older persons in the general population in The Netherlands. Second, to assess the association between SRLE and engagement in ACP. Methods. Cross-sectional study using data from the Longitudinal Aging Study Amsterdam (LASA) measurement wave of 2015-2016. Participants (n = 1585) were aged > 57 years. Results. Median age was 69.4 years (IQR: 64.1-76.7), and median SRLE 25.9 years (17.7-36.0). Formal engagement in ACP was present in 32.6%, informal without formal engagement in 45.8%, and 21.6% was not engaged in ACP. For respondents with SRLE < 25 years, there was a nonstatistically significant association between SRLE and engagement in ACP (aOR: 0.97; 95% CI: 0.93-1.01; P= .088), and a statistically significant, small association with formal vs. informal engagement in ACP (aOR: 0.96; 0.93-0.99; P= .009). For respondents with SRLE > 25 years there was no association between SRLE and engagement in ACP. Conclusion. The perception of approaching end of life is associated with higher prevalence of formal engagement in ACP, but only for those with SRLE < 25 years. For clinicians, asking patients after their SRLE might serve as a starting point to explore readiness for ACP. J Pain Symptom Manage 2021;62:757-767. (c) 2021 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)",

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author = "N. Fleuren and M.F.I.A. Depla and H.R.W. Pasman and D.J.A. Janssen and B.D. Onwuteaka-Philipsen and C.M.P.M. Hertogh and M. Huisman",

note = "Funding Information: Funding: This work was supported by the Netherlands Organisation for Health Research and Development , grant 839120002 . The funder had no role in the design of this study, analyses, interpretation of the data, or decision to submit results. Publisher Copyright: {\textcopyright} 2021 The Authors",

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doi = "10.1016/j.jpainsymman.2021.02.019",

language = "English",

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T1 - Association Between Subjective Remaining Life Expectancy and Advance Care Planning in Older Adults: A Cross-Sectional Study

AU - Fleuren, N.

AU - Depla, M.F.I.A.

AU - Pasman, H.R.W.

AU - Janssen, D.J.A.

AU - Onwuteaka-Philipsen, B.D.

AU - Hertogh, C.M.P.M.

AU - Huisman, M.

N1 - Funding Information: Funding: This work was supported by the Netherlands Organisation for Health Research and Development , grant 839120002 . The funder had no role in the design of this study, analyses, interpretation of the data, or decision to submit results. Publisher Copyright: © 2021 The Authors

PY - 2021/10/1

Y1 - 2021/10/1

N2 - Context. Advance care planning (ACP) becomes more relevant with deteriorating health or increasing age. People might be more inclined to engage in ACP as they feel that they are approaching end of life. The perception of approaching end of life could be quantified as subjective remaining life expectancy (SRLE). Objectives. First, to describe the prevalence of ACP with health care providers or written directives ("formal engagement in ACP") and ACP with loved-ones ("informal engagement in ACP") among older persons in the general population in The Netherlands. Second, to assess the association between SRLE and engagement in ACP. Methods. Cross-sectional study using data from the Longitudinal Aging Study Amsterdam (LASA) measurement wave of 2015-2016. Participants (n = 1585) were aged > 57 years. Results. Median age was 69.4 years (IQR: 64.1-76.7), and median SRLE 25.9 years (17.7-36.0). Formal engagement in ACP was present in 32.6%, informal without formal engagement in 45.8%, and 21.6% was not engaged in ACP. For respondents with SRLE < 25 years, there was a nonstatistically significant association between SRLE and engagement in ACP (aOR: 0.97; 95% CI: 0.93-1.01; P= .088), and a statistically significant, small association with formal vs. informal engagement in ACP (aOR: 0.96; 0.93-0.99; P= .009). For respondents with SRLE > 25 years there was no association between SRLE and engagement in ACP. Conclusion. The perception of approaching end of life is associated with higher prevalence of formal engagement in ACP, but only for those with SRLE < 25 years. For clinicians, asking patients after their SRLE might serve as a starting point to explore readiness for ACP. J Pain Symptom Manage 2021;62:757-767. (c) 2021 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

AB - Context. Advance care planning (ACP) becomes more relevant with deteriorating health or increasing age. People might be more inclined to engage in ACP as they feel that they are approaching end of life. The perception of approaching end of life could be quantified as subjective remaining life expectancy (SRLE). Objectives. First, to describe the prevalence of ACP with health care providers or written directives ("formal engagement in ACP") and ACP with loved-ones ("informal engagement in ACP") among older persons in the general population in The Netherlands. Second, to assess the association between SRLE and engagement in ACP. Methods. Cross-sectional study using data from the Longitudinal Aging Study Amsterdam (LASA) measurement wave of 2015-2016. Participants (n = 1585) were aged > 57 years. Results. Median age was 69.4 years (IQR: 64.1-76.7), and median SRLE 25.9 years (17.7-36.0). Formal engagement in ACP was present in 32.6%, informal without formal engagement in 45.8%, and 21.6% was not engaged in ACP. For respondents with SRLE < 25 years, there was a nonstatistically significant association between SRLE and engagement in ACP (aOR: 0.97; 95% CI: 0.93-1.01; P= .088), and a statistically significant, small association with formal vs. informal engagement in ACP (aOR: 0.96; 0.93-0.99; P= .009). For respondents with SRLE > 25 years there was no association between SRLE and engagement in ACP. Conclusion. The perception of approaching end of life is associated with higher prevalence of formal engagement in ACP, but only for those with SRLE < 25 years. For clinicians, asking patients after their SRLE might serve as a starting point to explore readiness for ACP. J Pain Symptom Manage 2021;62:757-767. (c) 2021 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

KW - Advance care planning

KW - life expectancy

KW - goals of care

KW - decision making

KW - patient preferences

KW - DEFINITION

KW - CANCER

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DO - 10.1016/j.jpainsymman.2021.02.019

M3 - Article

C2 - 33631323

SN - 0885-3924

VL - 62

SP - 757

EP - 767

JO - Journal of Pain and Symptom Management

JF - Journal of Pain and Symptom Management

IS - 4

ER -