101. EFFECTS OF PSYCHIATRIC DIAGNOSIS ON MEDICAL DIRECTIVE USAGE IN OLDER ADULTS: A LARGE DATASET EMR ANALYSIS AT A SAFETY-NET METROPLEX HOSPITAL

Abstract

Introduction

Background: It is estimated that only 1/3rd of US adults will detail an Advance Directive in their lifetime. Advance directive completion is associated with a decreased risk of hospitalization, higher concordance between the individual’s end-of-life wishes with the provided care, and amelioration of the caregiver’s stress (Sedini et al., 2022). However, little is known about the intersection of psychiatric diagnoses, including neurocognitive disorders, on MAD usage. Thus, the goal of this study is to establish a robust framework on MAD usage through a novel EMR analysis of a large metroplex city population and elucidate how the adoption of MADs is influenced by psychiatric diagnoses.

Methods

Methods: A retrospective analysis of electronic record encounters for all adults (age > = 18 years) with a 2022 inpatient admission (n = 41,421) at Parkland Memorial hospital was conducted. To identify the presence of an Advance Directive, these records were queried for attachments with MAD-related titles. MAD adoption rates among patients with and without psychiatric diagnoses were compared.

Results

Results: 41,421 patients were included in the study (age= 43.75 ± 17.53 years, mean ± SD) from which 15,143 patients identified as male, and 26,278 patients identified as female. Across all patients, the adoption of medical advance directives was 8.75%. Among those who had a psychiatric diagnosis, 14.0% of patients utilized a form of advance directive while, among those who did not have a psychiatric diagnosis, only 6.1% had an advance directive (p < 0.001). Compared to the population without a psychiatric diagnosis, those that had diagnoses related to neurocognitive disorders had a 25.7% higher use rate of advance directives (p < 0.001). Similarly, comparing patients from other psychiatric disorder groups to the general population, the Anxiety/Depression, Substance Use Disorder, and Schizophrenia/Bipolar, had a 17.6%, 11.7%, and 10.5% increase in MAD usage, respectively (p < 0.001 for all three comparisons).

Conclusions

Conclusion: Despite known healthcare disparities for patients with psychiatric disorders, our results indicated that MAD usage is greater amongst those who have a psychiatric diagnosis compared to patients who do not. In particular, patients with neurocognitive disorders had higher rates of MAD usage, especially in comparison to patients with other psychiatric diagnoses. Further studies will investigate the potential confounding effects of age, race, and gender on MAD usage in patients with psychiatric comorbidities. Particularly given the health disparities faced by patients with neurocognitive disorders and other psychiatric diagnoses, medical centers must create systems-level interventions to promote inclusive and empowering MAD usage amongst older adults.