title: Advance care planning for older people in Australia presenting to the emergency department from the community or residential aged care facilities.
abstract: The purpose of this retrospective, cross-sectional study was to determine the prevalence of advance care planning (ACP) among older people presenting to an Emergency Department (ED) from the community or a residential aged care facility. The study sample comprised 300 older people (aged 65+ years) presenting to three Victorian EDs in 2011. A total of 150 patients transferred from residential aged care to ED were randomly selected and then matched to 150 people who lived in the community and attended the ED by age, gender, reason for ED attendance and triage category on arrival. Overall prevalence of ACP was 13.3% (n = 40/300); over one-quarter (26.6%, n = 40/150) of those presenting to the ED from residential aged care had a documented Advance Care Plan, compared to none (0%, n = 0/150) of the people from the community. There were no significant differences in the median ED length of stay, number of investigations and interventions undertaken in ED, time seen by a doctor or rate of hospital admission for those with an Advance Care Plan compared to those without. Those with a comorbidity of cerebrovascular disease or dementia and those assessed with impaired brain function were more likely to have a documented Advance Care Plan on arrival at ED. Length of hospital stay was shorter for those with an Advance Care Plan [median (IQR) = 3 days (2-6) vs. 6 days (2-10), P = 0.027] and readmission lower (0% vs. 13.7%). In conclusion, older people from the community transferred to ED were unlikely to have a documented Advance Care Plan. Those from residential aged care who were cognitively impaired more frequently had an Advance Care Plan. In the ED, decisions of care did not appear to be influenced by the presence or absence of Advance Care Plans, but length of hospital admission was shorter for those with an Advance Care Plan.
authors.affiliation: Eastern Health - Deakin University Nursing and Midwifery Research Centre, Box Hill, Victoria, Australia.|School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.
authors.forename: Maryann
authors.identifier: http://orcid.org/0000-0002-5615-141X
authors.initials: M
authors.lastname: Street
authors.affiliation: School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.|Uniting Care Community Options, Glen Waverley, Victoria, Australia.
authors.forename: Goetz
authors.initials: G
authors.lastname: Ottmann
authors.affiliation: School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.
authors.forename: Megan-Jane
authors.initials: MJ
authors.lastname: Johnstone
authors.affiliation: Eastern Health - Deakin University Nursing and Midwifery Research Centre, Box Hill, Victoria, Australia.|School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.|Centre for Quality and Patient Safety Research, Deakin University, Burwood, Victoria, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Considine
authors.affiliation: Eastern Health - Deakin University Nursing and Midwifery Research Centre, Box Hill, Victoria, Australia.|School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.|Faculty of Health, Deakin University, Burwood, Victoria, Australia.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Livingston
mesh_terms: D032722:Advance Care Planning / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006707:Homes for the Aged; D006760:Hospitalization; D006801:Humans; D057187:Independent Living; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies
keywords: advance care planning; advance directives (medical care); domiciliary aged care; emergency departments; end-of-life care; residential aged care