Advance Care Planning: including Persons with Dementia and their Caregivers (GP105)

Outcomes 1. Learners will identify one best practice for advance care planning among persons with dementia. 2. Learners will contrast experiences of advance care planning by level of cognitive impairment. Key Message By studying actual ACP conversations among persons with dementia, we demonstrated that older adults with cognitive impairment can participate in advance care planning conversations with support from caregivers. This evidence can guide best practices and support future ACP initiatives, which may result in reducing burdensome end-of-life care and family conflict. Importance Best practice recommendations for advance care planning (ACP) in persons living with dementia are based on provider perspectives. With worsening impairment, there is increased need for family caregivers to engage in medical decision-making. Evidence is needed to inform practice and guide ACP. Objective(s) We qualitatively compare ACP experiences in a sample of older adults with cognitive impairment and their family caregivers by level of cognitive impairment. Scientific Methods Utilized We analyzed transcripts of audio-recorded ACP conversations (n=88). Four aspects of ACP were explored by level of cognitive impairment (normal-mild vs. moderate and severe): 1) Values Elicitation; 2) Surrogate Decision Making; 3) Goals of Care and End of Life Treatment Preferences and 4) Agreement and Conflict in ACP. Results Older adults' mean age was 88 years, 62.5% were female, 25% were Black, 50% reported financial strain; 83% had moderate/severe cognitive impairment. Caregivers were mostly adult children (67%) and female (83%). Across aspects of ACP, older adults with mild cognitive impairment interacted independently, articulating their own values and decisions. Moderately impaired older adults expressed preferences in ACP conversations with more support from caregivers needed in deciding treatment preferences. Caregivers of older adults with severe cognitive impairment were verbally active and assumed the dominant role in ACP decisions. However, several older adults with severe impairment were able to share their values and identify their surrogate. Generally, patients and caregivers were in agreement on ACP decisions and conflict was rare. Conclusion(s) Our findings support best practice recommendations for early ACP to increase patient engagement and ability of older adults with cognitive impairment to participate in ACP with support. Impact By studying actual ACP conversations among persons with dementia, even the oldest old, and caregivers the evidence from this study can guide best practices and support future ACP initiatives, which may result in reducing burdensome end-of-life care and family conflict.