Prevalence and factors associated with informal advance care planning discussion and do-not-resuscitate directives in patients at geriatric clinics.

Abstract

Background: Advance care planning (ACP) discussions and do-not-resuscitate (DNR) directives are essential for ensuring quality end-of-life care, especially for older adults with multiple comorbidities. This study aimed to investigate the prevalence and associated factors of informal ACP discussions and DNR directives among geriatric outpatients in Taiwan.

Methods: A cross-sectional study was conducted among 276 Taiwanese geriatric outpatients aged 65 years and older. Data on demographics, comorbidities, functional status, informal ACP discussions, and DNR directives were collected. Multinomial logistic regression was used to analyze the association between independent variables and dependent variables (ACP discussion experience and DNR directives).

Results: While 92.1 % of participants reported having informal ACP discussions, only 8.3 % had completed DNR directives. Compared to those who only discussed ACP (reference group), individuals with a one-point higher Cumulative Illness Rating Scale for Geriatrics score were significantly more likely to have both discussed ACP and completed DNR directives (odds ratio [OR] = 1.14, 95 % confidence interval [CI]: 1.01-1.29, p = .035). Conversely, individuals with junior high school education or higher (OR = 0.25, 95 % CI: 0.08-0.84, p = .025) and those dependent on others for activities of daily living (ADL dependence; OR = 0.24, 95 % CI: 0.07-0.86, p = .029) were significantly less likely to have neither informally discussed ACP nor completed DNR directives.

Conclusion: While Taiwanese older outpatients often informally discussed ACP, the completion of DNR directives was less common. The link between higher geriatric comorbidity and DNR directives highlights the need for proactive, tailored interventions in this population.