title: What factors are associated with having an advance directive among older adults who are new to long term care services?
abstract: OBJECTIVE
  To explore differences in having an advance directive among older adults newly transitioned to long term services and support (LTSS) settings (ie, nursing homes [NHs]; assisted living facilities [ALFs]; home and community-based services).
  
  
  METHODS
  Cross sectional survey.
  
  
  METHODS
  LTSS in New York and Pennsylvania.
  
  
  METHODS
  Participants were 470 older adults who recently started receiving LTSS. Included in this analyses, N = 442 (ALF: n = 153; NH: n = 145; home and community-based services: n = 144).
  
  
  METHODS
  Interviews consisted of questions about advance directives (living will and health care power of attorney), significant health changes in the 6 months before the start of long term care support services, Mini-Mental State Examination, and basic demographics.
  
  
  RESULTS
  Sixty-one percent (270/442) of older adults receiving LTSS reported having either a living will and/or an health care power of attorney. ALF residents reported having an advance directive more frequently than NH residents and older adults receiving LTSS in their own home (living will: χ(2)[2]= 120.9; P < .001; health care power of attorney: χ(2)[2]= 69.1; P < .001). In multivariate logistic regression models, receiving LTSS at an ALF (OR = 5.01; P < .001), being white (OR = 2.87; P < .001), having more than 12 years of education (OR = 2.50; P < .001), and experiencing a significant health change in past 6 months (OR = 1.97; P = .007) were predictive of having a living will. Receiving LTSS at an ALF (OR = 4.16; P < .001), having more than 12 years of education (OR = 1.74, P = .022), and having had a significant change in health in the last 6 months (OR = 1.61; P = .037) were predictive in having an health care power of attorney in this population of LTSS recipients.
  
  
  CONCLUSIONS
  These data provide insight into advance directives and older adults new to LTSS. Future research is needed to better understand the barriers to completing advance directives before and during enrollment in LTSS as well as to assess advance directive completion changes over time for this population of older adults.
authors: School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA. hirschk@nursing.upenn.edu
authors: Karen B
authors: KB
authors: Hirschman
authors: Katherine M
authors: KM
authors: Abbott
authors: Alexandra L
authors: AL
authors: Hanlon
authors: Janet
authors: J
authors: Prvu Bettger
authors: Mary D
authors: MD
authors: Naylor
mesh_terms: D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009518:New York; D009735:Nursing Homes; D010414:Pennsylvania