title: Single-centre cross-sectional analysis of advance care planning among elderly inpatients.
abstract: BACKGROUND
  Advance care planning (ACP) has been shown to provide beneficial outcomes for elderly patients; however, it may not be commonly implemented.
  
  
  OBJECTIVE
  To assess prevalence of advance care directives (ACD) and documented medical orders about end-of-life care for elderly inpatients; to explore the feasibility of an ACP screening interview.
  
  
  METHODS
  A single-centre cross-sectional analysis of 100 consecutive patients aged ≥80 years admitted for ≥48 h to a tertiary referral hospital, conducted between 16 and 18 January 2013. Medical records were reviewed for presence of (i) an ACD, (ii) resuscitation/end-of-life care intervention orders (REOL) and (iii) documented substitute decision-maker (SDM). If patients were able and willing to participate they completed an ACP screening interview exploring (i) their views on ACP and (ii) if an ACD was previously documented.
  
  
  RESULTS
  In 100 medical records, there were: zero ACD, 17 REOL and 8 with clear documentation of patients' preferred SDM. Out of 100 patients, 33 completed the interview: 32 (97%) were able to identify their preferred SDM, in 9 (27%) the nominated SDM was different from their 'next of kin'. Out of 33, 7 (21%) reported having an enduring guardian, 4/33 (12%) an ACD. Out of 29, 23 (79%) interviewees without an ACD were interested in discussing ACP further. Out of 30, 8 (27%) interviewees without REOL said that they would not wish to have aggressive life-prolonging measures. No patients reported discomfort with the screening interview.
  
  
  CONCLUSIONS
  ACD and correct documentation of SDM were uncommon in the medical records in this sample of elderly inpatients. The ACP screening interview appears feasible and acceptable and may be a useful tool for identifying patients' preferred SDM and willingness to discuss ACP further.
authors.affiliation: Department of Palliative Care, Royal North Shore Hospital, Sydney, New South Wales, Australia; Department of Aged Care, Royal North Shore Hospital, Sydney, New South Wales, Australia; Department of Aged Care, Blacktown District Hospital, Sydney, New South Wales, Australia; HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Sydney, New South Wales, Australia.
authors.forename: F
authors.initials: F
authors.lastname: Cheang
authors.forename: T
authors.initials: T
authors.lastname: Finnegan
authors.forename: C
authors.initials: C
authors.lastname: Stewart
authors.forename: A
authors.initials: A
authors.lastname: Hession
authors.forename: J M
authors.initials: JM
authors.lastname: Clayton
mesh_terms: D032722:Advance Care Planning / Q000331:legislation & jurisprudence / Q000592:standards; D016223:Advance Directives / Q000331:legislation & jurisprudence / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003657:Decision Making; D004282:Documentation / Q000592:standards; D005240:Feasibility Studies; D005260:Female; D016330:Frail Elderly; D006299:Health Services for the Aged / Q000331:legislation & jurisprudence / Q000592:standards; D006801:Humans; D008297:Male; D008499:Medical Records; D057240:Patient Preference; D036301:Qualitative Research; D016414:Resuscitation Orders
keywords: advance care planning; advance directives; aged 80 and over; decision-making; terminal care