Cognitive performance and attitudes towards advanced end-of-life care planning in older adults
S. Vilpert1, R. Reinecke1, G. D. Borasio1, J. Maurer1 (1Lausanne)
The completion of an advance directive to make medical decisions for a hypothetical future requires cognitive competencies, such as planning, organization, and initiation. Cognitive decline can affect the ability to make these decisions and even prevent making them if it develops into dementia or Alzheimer's disease.
This study aims to better understand the association of different cognitive competencies, and global cognitive performance with attitudes and behaviours towards advance care planning.
Measures of cognitive competencies are based on temporal orientation, numeracy, immediate and delayed memory, and verbal fluency and are dichotomised into the presence or absence of impairment for each competency. The sum of the five cognitive measures is the global cognitive performance (ranging from 1 to 5). Measures of cognitive competencies are regressed on attitudes (“having discussed end-of-life preferences”, “having or planning to have an advance directive”) and behaviours (“having an advance directive”, “having appointed a healthcare proxy”). Our analyses are based on a nationally representative sample of adults aged 55 and over (n=1’933) from a paper-and-pencil questionnaire, part of the Swiss component study of the Survey of Health, Aging and Retirement in Europe (SHARE) in 2015.
Three out of five measures of cognitive competency −immediate and delayed memory, verbal fluency− are positively associated with favourable attitudes towards end-of-life care planning, but only the associations of verbal fluency remain statistically significant once all the measures of cognitive competency and controls are inserted in the regressions. A one-point increase of the global cognitive performance raises by 4.3 percentage points the chance of having discussed end-of-life preferences, and by 2.3 percentage points the chance of having an advance directive.
Higher cognitive performance is likely to help plan and make end-of-life care decisions in advance, especially better verbal fluency. This finding indicates that individuals with poorer cognitive performance are less likely to make arrangements for their future end-of-life care while more exposed to cognitive and functional decline and mortality risk. There is a need to reach out to people presenting cognitive impairments to plan their end-of-life care before it is too late and provide them with appropriate support in carrying out this process.