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

Nienke Fleuren*, Marja F.I.A. Depla, H. Roeline W. Pasman, Daisy J.A. Janssen, Bregje D. Onwuteaka-Philipsen, Cees M.P.M. Hertogh, Martijn Huisman

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-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.

Original languageEnglish
Pages (from-to)757-767
Number of pages11
JournalJournal of Pain and Symptom Management
Volume62
Issue number4
Early online date23 Feb 2021
DOIs
Publication statusPublished - Oct 2021

Bibliographical 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:
© 2021 The Authors

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

Keywords

  • Advance care planning
  • decision making
  • goals of care
  • life expectancy
  • patient preferences

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