Older people want more opportunities to plan their care, says research

A new study reveals that patients are increasingly planning for end-of-life care, but services aren’t always available.

Older people who want to talk to health professionals about advance care planning (ACP) are not always able to do so, a new study published in Age & Ageing, the medical journal of the British Geriatrics Society, has revealed.

More than a third of respondents in the East Midlands study said that they would be interested in discussing advance care plans with a health professional. However, only 17 per cent of respondents had prepared an advance care plan, and only 5 per cent had been actively offered the opportunity to talk about it with a health professional.

Advance care planning is a process of assessment and dialogue to document an individual’s preferences for future care and treatment. It can result in ‘advance’ directives (often referred to as ‘Living Wills’) that record views on specific treatments, the nomination of a proxy to represent the individual if they lose mental capacity, and statements of values and views about care and treatment.

Speaking on behalf of the British Geriatrics Society, Professor Adam Gordon said: "Doctors and health care professionals often feel nervous about exploring issues around advance care planning in case they offend or unduly distress patients. This sometimes stops them preparing these plans in discussion with patients, even when they think it might be in a patient's best interests.

“This study tells us they should be less nervous and more forward in introducing advance care planning concepts. Such discussions, though, can take time and this is one of many reasons we need to reflect upon the time available to general practitioners for routine consultations in older patients with frailty and work to increase resources in primary care to support patient-centred care planning."

This study received responses from 1,823 people aged 65 and over, living in community settings and recorded an increase in the number of patients putting advance care plans in place (up from 8 per cent in a 2005 poll). The study concludes that these results should encourage healthcare professionals to explore what people understand by ACP, and the role of professionals in providing it.

One report author, Irfana Musa of Leicester Royal Infirmary, said: “With the population growing older and living longer, we are treating many more conditions such as dementia, in which an individual’s decision making ability becomes impaired. Advance Care Planning can help people think ahead and also inform others of their wishes in anticipation of a time when they cannot communicate themselves.

“This study gives us a flavour of what the population understand by Advance Care Planning, whether they would engage in the process, and what the barriers might be."

The research paper, entitled ‘Older People's Attitudes to Advance Care Planning’ is available in the current issue of Age & Ageing.