The Relationship Between Advance Care Planning and Cognitive Function in a Multicultural Cohort

Abstract

Engagement in Advance care planning (ACP) – the process of communicating preferences for future medical decisions, has been linked to increasing age, greater decision-making capacity, and higher education, and is more prevalent in White older adults. To advance knowledge of ACP in multicultural populations, we examined variations in the relationship between sociodemographics, cognitive functionality and ACP. A total of 303 older (mean-age: 69.4±10.5; 69.9% females; 29.6% Non-Hispanic White, 21.2% African American, and 49.2% Hispanic) participants in a community-based dementia screening program were included. ACP measures included life insurance, disability insurance, long-term care (LTC) insurance, power of attorney (POA), living will, and having a health care proxy (HCP). Although most participants had health insurance (92.4%, no differences by race), low rates of ACP engagement were found in racial/ethnic minorities across multiple ACP measures (all ≤40%). Black older adults had the highest use of life insurance (p<.001). Higher ACP rates (i.e., LTC, HCP, living will) were associated with better global cognition (MoCA; p< 0.05). Higher POA rates were associated with lower AD8 scores (30.1% in AD8< 2 vs 15.4% in AD8≥2, p=0.003). Finally, ACP rates varied across racial-SES groups being highest in high SES White participants and lowest in minorities with low SES, regardless of subjective or objective cognitive performance. Findings link ACP to greater cognitive functionality and highlight racial and SES disparities in ACP engagement, particularly related to non-insurance-based planning. Understanding cultural differences in decision making can lead to targeted interventions to increase early ACP in cognitive aging and dementia for older adults.