Evaluation of Neighborhood Socioeconomic Characteristics and Advance Care Planning Among Older Adults

Abstract

Advance care planning (ACP), a process by which people communicate their preferences for future medical care,^1,2 is associated with a higher likelihood of patients receiving care consistent with their goals and higher patient and family satisfaction with end of life care.^3-6 However, ACP rates are as low as 20% to 30% among older, socioeconomically disadvantaged populations—including people of color and those with lower income—compared with rates higher than 50% among older adults overall. Rates of documented ACP in the electronic health record (EHR) are even lower.^7-11 Known barriers to ACP include individual (eg, knowledge, attitudes) and health system level (eg, complexity of advance directive forms, lack of clinician training) factors. However, despite development of patient- and provider-facing programs to increase ACP,^12-17 overall rates of ACP have not increased appreciably among diverse older adults in the US.⁷