title: Unmarried patients with early cognitive impairment are more likely than their married counterparts to complete advance care plans.
abstract: Patients with early cognitive impairment (ECI) face the prospect of progressive cognitive decline that impairs their ability to make decisions on financial and personal matters. Advance care planning (ACP) is a process that facilitates decision making on future care and often includes identifying a proxy decision maker. This prospective study explores factors related to completion or non-completion of ACP in patients with ECI.
  
  
  
  Patients with ECI (n = 158, M age = 76.2 ± 7.25 years) at a memory clinic received psycho-education and counseling on the importance of ACP and followed-up longitudinally for up to 12 months to ascertain if ACP had been completed. Univariate and logistic regression were used to analyze factors related to completion and non-completion of ACP.
  
  
  
  Seventy-seven patients (48.7%) were initially willing to consider ACP after the counseling and psycho-educational session but only 17 (11.0%) eventually completed ACP. On logistic regression, patients who were single were 8.9 times more likely to complete ACP than those who were married (p = 0.007). Among those initially willing to consider ACP, factors impeding completion of ACP included patient (48.0%), process (31.0%), and family factors (21.0%).
  
  
  
  As unmarried patients may not have immediate family members to depend on to make decisions, they may perceive ACP to be more important and relevant. Understanding the barriers to ACP completion can facilitate targeted interventions to improve the uptake of ACP.
authors.affiliation: Geriatric Centre,Khoo Teck Puat Hospital,Alexandra Health System,90 Yishun Central,Singapore,768828,Singapore.
authors.forename: Tong Jen
authors.initials: TJ
authors.lastname: Lo
authors.affiliation: Geriatric Centre,Khoo Teck Puat Hospital,Alexandra Health System,90 Yishun Central,Singapore,768828,Singapore.
authors.forename: Ngoc Huong Lien
authors.initials: NH
authors.lastname: Ha
authors.affiliation: Geriatric Centre,Khoo Teck Puat Hospital,Alexandra Health System,90 Yishun Central,Singapore,768828,Singapore.
authors.forename: Chong Jin
authors.initials: CJ
authors.lastname: Ng
authors.affiliation: Ministry of Health Holdings,1 Maritime Square,Singapore,099253,Singapore.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Tan
authors.affiliation: Geriatric Centre,Khoo Teck Puat Hospital,Alexandra Health System,90 Yishun Central,Singapore,768828,Singapore.
authors.forename: Hui Mien
authors.initials: HM
authors.lastname: Koh
authors.affiliation: Geriatric Centre,Khoo Teck Puat Hospital,Alexandra Health System,90 Yishun Central,Singapore,768828,Singapore.
authors.forename: Philip Lin Kiat
authors.initials: PL
authors.lastname: Yap
mesh_terms: D032722:Advance Care Planning / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D060825:Cognitive Dysfunction / Q000523:psychology*; D003657:Decision Making; D003704:Dementia / Q000150:complications*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D011446:Prospective Studies; D019727:Proxy; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012846:Singapore
keywords: advance care planning; completion; early cognitive impairment; lasting power of attorney; non-completion; person-centered care