Advance care directive prevalence among older Australians

Ever wondered how prevalent Advance Care Directives were in older Australian’s? And the importance of having an Advance Care Directive? Read on to discover more:

According to an article published in Wiley titled Advance care directive prevalence among older Australians and associations with person-level predictors and quality indicators” in 2017, there were 56 million deaths globally, with 58% of these deaths recorded for people aged 65 years or older. (1)

While some individuals will die suddenly and unexpectedly, many will experience a prolonged period of deteriorating health, chronic illness, comorbidity and diminishing decision-making capacity prior to death. (2)

This period is associated with adverse health outcomes, including poorer quality of life, (3) increased hospitalizations, (4) unwanted and intensive medical treatments and greater health-care expenditure. (5)

While almost half of those nearing the end of life will require treatment decisions to be made, the majority will lack the capacity to make their own decisions. (6),(7)

Advance care planning (ACP) and related medical treatment legislation enable individuals to maintain choice and control over their health-care decisions in the event they lose decision-making capacity in the future.

ACP is an on-going process of reflection and discussion that supports a person to identify and discuss their goals, values and preferences for future care with health-care

providers and loved ones. (8)

The ultimate goal of ACP is that people receive medical care that is consistent with their preferences. (9)

ACP is associated with a range of beneficial outcomes for individuals, their families, health professionals and the health system. (6), (10-14)

However, a recent Australian study of people with cancer and support people found that ACP and assistance with the completion of ACDs were commonly not discussed as part of

standard care, despite two-thirds of consumers having discussed ACP with loved ones and approximately half wanting ACP discussions with their doctor. (15)

When it comes to Advance Care Directives, it’s best to seek legal advice.

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(1). Institute for Health Metrics -Evaluation.Global health data exchange.

Accessed 27 October 2020.

(2). Prince MJ, Wu F, Guo Y, et al. The burden of disease in older people and implications for health policy and practice. Lancet. 2015;385(9967):549-562.

(3). Marengoni A, Angleman S, Melis R, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev.2011;10(4):430-439.

(4). Soong J, Poots A, Scott S, et al. Quantifying the prevalence of frailty in English hospitals. BMJ open. 2015;5(10):1-11.

(5). Sirven N, Rapp T. The cost of frailty in France. Eur J Health Econ.2017;18(2):243-253.

(6). Silveira MJ, Wiitala W, Piette J. Advance directive completion by elderly Americans: a decade of change. J Am Geriatr Soc. 2014;62(4):706-710.

(7). Sullivan SS, Dickerson SS. Facing death: a critical analysis of advance care planning in the United States. Adv Nurs Sci. 2016;39(4):320-332.

(8). Sudore RL, Lum HD, You JJ, et al. Defining advance care planning for adults: a consensus definition from a multidisciplinary Delphi panel. J Pain Symptom Manage. 2017;53(5):821-832. e1.

(9). Sudore RL, Heyland DK, Lum HD, et al. Outcomes that define successful advance care planning: a Delphi panel consensus. J Pain Symptom Manage. 2018;55(2):245-255.e8.

(10). Brinkman-Stoppelenburg A, Rietjens JA, van der Heide A. The effects of advance care planning on end-of- life care: a systematic review. Palliat Med. 2014;28(8):1000-1025.

(11). Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end-of-life care in elderly patients: randomised controlled trial. BMJ Open. 2010;340:c1345.

(12). Houben CH, Spruit MA, Groenen MT, Wouters EF, Janssen DJ. Efficacy of advance care planning: a systematic review and meta-analysis. J Am Med Dir Assoc. 2014;15(7):477-489.

(13). Jimenez G, Tan WS, Virk AK, Low CK, Car J, Ho AHY. Overview of systematic reviews of advance care planning: summary of evidence and global lessons. J Pain Symptom Manage. 2018;56(3):436-459. e25.

(14). Wright AA, Zhang B, Ray A, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA.


(15). Rodi H, Detering K, Sellars M, et al. Exploring advance care planning awareness, experiences, and preferences of people with cancer and support people: an Australian online cross-sectional study. Support Care Cancer. 2020;0:1-12. 0-020-05878