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Frequency and Correlates of Advance Planning Among Cognitively Impaired Older Adults

From the Departments of Health and Community Systems (JHL, LG), Psychiatry (JHL, MAD, JTB, RS, STD), Neurology (JTB, STD), Psychology (MAD, JTB, RS), and Epidemiology (MAD, RS), University of Pittsburgh, Pittsburgh, PA; Alzheimer Disease Research Center (JHL, JTB, STD), University of Pittsburgh, Pittsburgh, PA; and University of Pennsylvania School of Nursing (KBH), Philadelphia, PA.

Objective: To examine the prevalence and sociodemographic correlates of written advance planning among patients with or at risk for dementia-imposed decisional incapacity.

Design: Retrospective, cross-sectional.

Setting: University-based memory disorders clinic.

Participants: Persons with a consensus-based diagnosis of mild cognitive impairment (N = 112), probable or possible Alzheimer disease (AD; N = 549), and nondemented comparison subjects (N = 84).

Intervention: N/A.

Measurements: Semistructured interviews to assess durable power of attorney (DPOA) and living will (LW) status upon initial presentation for a dementia evaluation.

Results: Sixty-five percent of participants had a DPOA and 56% had a LW. Planning rates did not vary by diagnosis. European Americans (adjusted odds ratio = 4.75; 95% CI, 2.40–9.38), older adults (adjusted odds ratio = 1.05; 95% CI, 1.03–1.07) and college graduates (adjusted odds ratio = 2.06; 95% CI, 1.33–3.20) were most likely to have a DPOA. Findings were similar for LW rates.

Conclusions: Although a majority of persons with and at risk for the sustained and progressive decisional incapacity of AD are formally planning for the future, a substantial minority are not.

Key Words: Mild cognitive impairment • Alzheimer disease • durable power of attorney • living will

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