Advanced Care Planning for Older Adults

1 Advanced Care Planning for Older Adults The health of a person tends to deteriorate with age. Wittenberg et al. (2015) noted that older adults have a heightened risk of developing a chronic condition. These conditions may complicate the health of an adult, making it challenging to participate in daily activities.

Therefore, it is vital to provide adults with the necessary support and resources to overcome the health challenges that emerge at certain points in life. Health care professionals can initiate advanced care planning for persons with long-term chronic conditions, acute illness, and terminal conditions to alleviate suffering, improve the quality of life, and facilitate medical decisionmaking.

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2 Advanced care planning (ACP) refers to the process of supporting adults of different ages and health statuses to understand and share values, preferences, and goals regarding future medical care. It involves assisting patients to make practical decisions regarding the type of healthcare they would want in case of a health crisis (Jabbarian et al., 2018). These decisions are based on the client’s preferences, personal choices, and values. The care provider discusses the available treatment options with the clients and assists them in documenting their wishes.

ACP is beneficial since it serves as a bridge to the gap between the healthcare patients want and the types of services they receive (Thomas, 2017). Every adult should have an ACP to guide the care process when one loses the capacity to make a practical medical decision. The ACP provides a base for health care professionals to have structured communication with patients regarding their treatment goals, personal values and interests, and location of care. ACP promotes client-centered care since it integrates personal preferences and interests into the care plan.

Thomas (2017) noted that healthcare provided to patients aligns with their preferences and treatment goals. This move lowers the cost of care by diminishing intensive and aggressive treatments at the end of life. Further, ACP boosts the care provider’s effectiveness in complying with the patient’s end-of-life wishes (Nishikawa et al., 2020). Significantly, ACP reduces the decisional burden of families, and care providers since the patient’s wishes are well documented.

It also eradicates moral distress among family members and critical care nurses in case of patient death.

Approach to Advanced Care Planning Conversations on the end of life care are among the most significant interactions between care providers and patients. These conversations are necessary when dealing with people

3 suffering from chronic conditions and terminal diseases. However, these interactions are incredibly challenging. Jabbarian et al. (2018) noted that health care professionals might find discussing end-of-life issues somehow challenging due to lack of adequate training and experience in this field and diversity of patient preferences, values, and interests. Clinicians also find it hard to determine if the patient will welcome the discussion on end of life or not.

However, as noted by Jabbarian et al. (2018), many patients are receptive to end-of-life discussions. Notably, the person who initiates the end-of-life discussion must uphold respect and demonstrate human dignity. The debate should focus more on the patient’s interests and preferences than other parties’ goals and interests.

Although no specific time is appointed to initiate ACP, palliative care professionals recommend that clinicians conduct these discussions before the death and hospitalization of a person (Thomas, 2017). Significantly, clinicians should reframe the conversation to ensure all end life issues are captured correctly. The discussion needs to be conducted in more than one session to avoid pressuring the client. The patient’s primary care provider should be directly involved in ACP to guide various medical decisions. All families need information concerning health care for their loved ones. Therefore, care providers need to initiate the conversation before the patient loses the ability to self-care and take part in medical decision-making (Wichmann et al., 2018).

In most cases, people choose to defer end-of-life care discussions until they experience an acute situation. Deferring ACP may help the patients think over their life and illness. Clinicians, however, need to inform their clients appropriately if the current situations do not allow them.

Clinicians may face some emotional challenges in initiating advanced care planning conversations with patients. Palliate care professionals recommend using conversation starters to

4 initiate ACP discussions (Wichmann et al., 2018). These starters include current issues, favorite movies, and TV shows. Other potential starters include medical checkups, sermons, the death of someone else, and funerals. In these conversations, the clinician needs to focus on gathering information on the client’s values and interests.

Elements and Documentation Advanced care planning contains information on the patient’s values, interests, goals, preferences, and other elements necessary to guide care processes at the end of life care (Sokolowski, 2018). This information covers medical and legal wishes, spiritual and personal wishes that enable families and care providers to understand how exactly one would like to be treated during the end of life care. Importantly, in ACP, individuals provide information concerning the people they want to make decisions on their behalf if they lose the decisionmaking ability (Mcnew, 2016). The ACP also includes the medical treatment the clients want to be provided with during end-of-life and the level of comfort they need during this critical moment. Notably, the client highlights how they would like information on their health and death to be disclosed to family members.

Health care professionals need to employ a strategic approach to ensure that ACP achieves the intended objective. The caregiver needs to assess the client’s health and likely prognosis and establish personal goals, values, and preferences (Jabbarian et al., 2018). The clinician should then discuss current and future interventions and personal care options. Notably, the patient’s substitute decision-makers need to be identified. The patient’s preferred treatment interventions should be documented to guide future care processes.

ACP documentation can be done on the power of attorney forms obtained from the state.

Clinicians could also use the universal ACP documentation forms approved by many states for

5 this purpose. A medical power of attorney is the best option to document the ACP. This form highlights the person responsible for making medical decisions on behalf of the patient (Sokolowski, 2018). Although it ensures the patient’s wishes are complied with, the competence of a power of attorney may deteriorate with time, thus becoming questionable. An individual can also abuse these powers. The ACP, therefore, needs to be reviewed when an individual’s medical condition, preferences, and competence of substitute decision-maker change.

Conclusion ACP is a significant process that guides clinicians in delivering healthcare services that align with personal needs and interests. ACP contains medical, legal, spiritual, and personal wishes. This process is usually initiated by primary care providers dealing with patients suffering from chronic and terminal conditions. Palliative care professionals recommend using an approach that demonstrates respect and human dignity when developing an ACP.

6 References Jabbarian, L.., Zwakman, M., van der Heide, A., Kars, M., Janssen, D., Van Delden, J., ... & Korfage, I. (2018). Advance care planning for patients with chronic respiratory diseases: a systematic review of preferences and practices. Thorax, 73(3), 222-230. https://dx.doi.org/10.1002%2F14651858.CD013022.pub2 Mcnew, C. E., (2016). Emergency department compliance manual 2016. Kluwer Law & Bus. Nishikawa, Y., Hiroyama, N., Fukahori, H., Ota, E., Mizuno, A., Miyashita, M., ... Rietjen, J., & Kwong, J. (2020). ACP for adults with heart failure. Cochrane Database of Systematic Reviews, 73(2), 222-230. http://dx.doi.org/10.1136/thoraxjnl-2016-209806 Sokolowski, M., (2018). Dementia & the advance directive: Lessons from the bedside. Springer Thomas, K. (2017). Advance care planning in end-of-life care. NY Oxford university press Wichmann, A.., van Dam, H., Thoonsen, B., Boer, T., Engels, Y., & Groenewoud, A. S. (2018).

ACP conversations with palliative patients: Looking through the GP’s eyes. BMC Family Practice, 19(1), 1-9. https://doi.org/10.1186/s12875-018-0868-5 Wittenberg, E., Ferrell, B., Goldsmith, J., Smith, T., Glajchen, M., Handzo, G., & Ragan, S. L. (Eds.). (2015). Textbook of palliative care communication. Oxford University Press.