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Advance care planning for older people in Australia presenting to the emergency department from the community or residential aged care facilities
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posted on 2015-09-01, 00:00 authored by Maryann StreetMaryann Street, Goetz Ottmann, Megan-Jane JohnstoneMegan-Jane Johnstone, Julie ConsidineJulie Considine, Trish LivingstonTrish LivingstonThe purpose of this retrospective, cross-sectional study was to determine the prevalence of advance care planning (ACP) among older people presenting to an Emergency Department (ED) from the community or a residential aged care facility. The study sample comprised 300 older people (aged 65+ years) presenting to three Victorian EDs in 2011. A total of 150 patients transferred from residential aged care to ED were randomly selected and then matched to 150 people who lived in the community and attended the ED by age, gender, reason for ED attendance and triage category on arrival. Overall prevalence of ACP was 13.3% (n = 40/300); over one-quarter (26.6%, n = 40/150) of those presenting to the ED from residential aged care had a documented Advance Care Plan, compared to none (0%, n = 0/150) of the people from the community. There were no significant differences in the median ED length of stay, number of investigations and interventions undertaken in ED, time seen by a doctor or rate of hospital admission for those with an Advance Care Plan compared to those without. Those with a comorbidity of cerebrovascular disease or dementia and those assessed with impaired brain function were more likely to have a documented Advance Care Plan on arrival at ED. Length of hospital stay was shorter for those with an Advance Care Plan [median (IQR) = 3 days (2-6) vs. 6 days (2-10), P = 0.027] and readmission lower (0% vs. 13.7%). In conclusion, older people from the community transferred to ED were unlikely to have a documented Advance Care Plan. Those from residential aged care who were cognitively impaired more frequently had an Advance Care Plan. In the ED, decisions of care did not appear to be influenced by the presence or absence of Advance Care Plans, but length of hospital admission was shorter for those with an Advance Care Plan.
History
Journal
Health and social care in the communityVolume
23Issue
5Pagination
513 - 522Publisher
WileyLocation
Milton, QldPublisher DOI
ISSN
0966-0410eISSN
1365-2524Language
engPublication classification
C Journal article; C1 Refereed article in a scholarly journalCopyright notice
2014, WileyUsage metrics
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No categories selectedKeywords
advance care planningadvance directives (medical care)domiciliary aged careemergency departmentsend-of-life careresidential aged careScience & TechnologySocial SciencesLife Sciences & BiomedicinePublic, Environmental & Occupational HealthSocial WorkOF-LIFE CAREPALLIATIVE CARECANCER-PATIENTSDIRECTIVESENDATTITUDESMODELGAY
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