Incidence and predictors of advance care planning among persons with cognitive impairment.
Open accessAbstract
Objective Persons with mild cognitive impairment (MCI) and Alzheimer disease (AD) are at heightened risk for future decisional incapacity. We sought to characterize advance care planning (ACP) rates over time in individuals who had no advance directives (living will or durable power of attorney) in place when they initially presented for a cognitive evaluation.Design Retrospective analysis of data that had been prospectively collected.Setting Alzheimer's Disease Research Center memory disorders clinic.Participants Persons (N = 127) with a diagnosis of MCI or early AD (n = 72) or moderate to severe AD (n = 55) and no advance directives upon initial presentation for a cognitive evaluation.Measurements Extraction of responses to items pertaining to ACP assessed during annual semistructured interviews.Results By 5 years of follow-up, 39% of the sample had initiated ACP, with little difference by baseline diagnosis. Younger subjects (younger than 65 years) were significantly more likely to initiate advance directives (43%) than older subjects (37%). This age effect was more pronounced in men than in women as well as in married subjects, those with a family history of dementia, those with no depressive disorder, and subjects with moderate to severe AD (versus those with MCI or early AD) at baseline.Conclusion Only a minority of subjects initiated ACP. The findings suggest the need for interventions aimed at enhancing ACP completion rates, particularly among older adults with cognitive impairment, since these individuals may have a time-limited opportunity to plan for future medical, financial, and other major life decisions.
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Males with a dementia diagnosis showed a higher tendency to participate in ACP than females.
“Also, males with a dementia diagnosis showed a higher tendency to participate in ACP than females [37].”
From Acceptability of the voice your values, an advance care planning intervention in persons living with mild dementia using videoconferencing technology (2022) · cites this paper as [37]
The Results (Advance Care Planning) show an age-dependent pattern: 60% of men under 65 completed ACP, compared with 21% of women under 65, but the pattern reversed among older participants (30% of men versus 45% of women). The same section states that ACP completion rates did not vary significantly by gender overall. The claim omits the age qualification and overstates a general male–female difference. (LLM, conf=0.88)
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- Authors
- Garand, L., Dew, M. A., Lingler, J. H., & DeKosky, S. T.
- Affiliations
- University of Pittsburgh (US)
- Corresponding author
- Garand, Linda
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2011-08
- Volume
- 19
- Issue
- 8
- Pages
- 712-720
- ISSN
- 1064-7481 (ISSN-L)
- PMC
- PMC3145957
- OpenAlex
- W1974500301
- Cited by
- 84
- References
- 48
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 4 · 2023: 7 · 2022: 7 · 2021: 8 · 2020: 4 · 2019: 6 · 2018: 9 · 2017: 4 · 2016: 1 · 2015: 6 · 2014: 7 · 2013: 6 · 2012: 7
- FWCI
- 6.27
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Funders
- National Institute on Aging (AG 05-133, P50AG005133)
- National Institute of Mental Health (K23MH070719, MH070719)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Keywords
- advance care planning, advance directives, living wills, durable power of attorney, mild cognitive impairment, Alzheimer's disease, decisional incapacity, age differences, sex differences, marital status, family history of dementia, depressive disorders, older adults
- MeSH terms
- Aged, Alzheimer Disease, Cognition Disorders, Depression, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pennsylvania, Retrospective Studies, Geriatric Assessment, Incidence, Advance Directives, Advance Care Planning
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