Physician involvement in life transition planning: a survey of community-dwelling older adults

Hillary D. Lum, Jared B. Brown, Elizabeth Juarez-Colunga, Marian E. Betz

With many information sources for healthy aging and life transitions, it is unknown whether community-dwelling older adults desire physician involvement in future planning decisions. The study aimed to examine older adults' experiences and opinions concerning four future planning domains: advance care planning, driving, finances, and housing. Adults aged ≥55 years living at a large urban, independent living facility were surveyed with an anonymous, voluntary, paper-based, mailed questionnaire. Survey domains were advance care planning, driving, finances, and housing. For each domain, questions assessed confidence, openness to discussions, information sources, and prior and desired future role of the physician in decision-making by domain. Comparisons across and within domains were determined using Chi-square tests. The response rate was 56 % (N = 457; median age: 75 years; 74 % female). Among advance care planning, driving, and finances, respondents were more confident about what it means to have an advance directive (87 %, 95 % CI 84 - 90 %) than alternative transportation options (46 %, 95 % CI 42 - 51 %). Nearly two-thirds of respondents (64 %, 95 % CI 59 - 68 %) were open to discussing driving cessation, though only one-third (32 %, 95 % CI 28 - 37 %) were open to having a family member determine timing of driving cessation. More individuals (44 %, 95 % CI 39 - 49 %) were open to a physician deciding about when to stop driving. Past discussions with family or friends about advance care planning or finances were common, although past discussions about driving were less common. Respondents reported personal experience and family as key information sources, which were significantly more common than healthcare providers. While prior involvement by physicians in decision-making was rare across all domains, some respondents expressed desire for future physician involvement in all domains, with advance care planning (29 %, 95 % CI 25 - 33 %) and driving safety (24 %, 95 % CI 20 - 28 %) having highest levels of support for future physician involvement. Some older adults desired more physician involvement in future planning for life transitions, especially related to advance care planning and driving compared to finances and housing. Clinical implications include increased patient-centered care and anticipatory guidance by physicians for aging-related life transitions.