Prevalence and factors associated with Advance Health Directives in frail older inpatients

BACKGROUND: Advance health directives (AHDs) can be used to explore and document patient preferences for treatment and are therefore an important aspect of care planning. AIMS: To investigate the prevalence and factors associated with AHDs among older inpatients. METHODS: This retrospective study included 6449 patients, aged >/=65 years referred for specialist geriatric consultation between 2007 and 2018 in Queensland, Australia. The interRAI-Acute Care Comprehensive Geriatric Assessment tool was used to calculate a frailty index (FI), range 0-1, based on 52 possible deficits, and categorised into intervals of 0.1 for analysis. FI was also grouped according to previously reported cut points: fit (FI 0.25-0.4), frail (FI >0.4-0.6) and severely frail (FI >0.6). RESULTS: An AHD was present in 1032/6449 (16.0%) patients. Those with an AHD were significantly frailer than those without an AHD (mean FI 0.52 vs 0.45; p < 0.001). Higher frailty (OR:1.34(1.27-1.40)), older age (OR:1.04(1.03-1.05)), living in an institution (OR:1.33(1.01-1.73)), and recent hospitalisation (OR:1.42(1.23-1.62)) were significantly associated with higher prevalence of AHDs. Prevalence of AHD increased over time, from 7.6%(n = 66) in 2008 to 35.4%(n = 99) in 2017. CONCLUSION: The presence of AHDs is associated with sociodemographic factors, as well as higher frailty levels. Prevalence of AHDs among inpatients has increased over the past decade but remains modest. This article is protected by copyright. All rights reserved.