Planning for the Future
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Planning for the Future

Older Australians are being encouraged to plan for their future. This can include sorting out legal and financial affairs, getting home help or applying for residential aged care, and planning for end of life care.

Advance Care Planning (ACP) is shared planning for future health care. It involves talking about and documenting values, beliefs and preferences to guide decision-making when a person cannot make or communicate their decisions.

While everyone should consider ACP, it can be particularly important for people with an advanced chronic illness, a life-limiting illness, and those people who are planning for retirement or those at risk of living with declining cognition. This process can help health professionals and a person’s family and friends know what kind of treatment and care the person would want in the future.

However a recent study showed that only around one-third of older Australians in the participating general practices, hospitals and residential aged care facilities had at least one ACD in their health record. Most of these were non-statutory documents. [1]

Planning for end-of-life in dementia can be beneficial but needs to be started early. In practice, however, these discussions may not take place or may start too late. [2] People vary in their ability to understand and make decisions, and these abilities can change over time. While there are few guidelines available for healthcare professionals concerning ACP in people living with dementia, especially those with early onset dementia, there is an increasing body of research that can help frame approaches. [3] These can be seen in resources developed by groups such as Advance Care Planning Australia and Dementia Australia. Supported decision-making is also being examined as a way to help and assist people with disabilities and potentially with dementia to make decisions about their lives. [4]

Page created 25 June 2019

  • References

  1. Detering KM, Buck K, Ruseckaite R, Kelly H, Sellars M, Sinclair C, et al. Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services: multicentre audit study. BMJ Open 2019 Jan 15;9(1):e025255. doi: 10.1136/bmjopen-2018-025255.
  2. van der Steen JT, van Soest-Poortvliet MC, Hallie-Heierman M, Onwuteaka-Philipsen BD, Deliens L, de Boer ME, et al. Factors associated with initiation of advance care planning in dementia: a systematic review. J Alzheimers Dis. 2014;40(3):743-57. doi: 10.3233/JAD-131967.
  3. Piers R, Albers G, Gilissen J, De Lepeleire J, Steyaert J, Van Mechelen W, et al. Advance care planning in dementia: recommendations for healthcare professionals. BMC Palliative Care 2018 Jun 21;17(1):88. doi: 10.1186/s12904-018-0332-2.
  4. Sinclair C, Field S, Williams K, Blake M, Bucks R, Auret K, et al. Supporting decision-making: A guide for people living with dementia, family members and carers (1.98MB pdf). Sydney: Cognitive Decline Partnership Centre, 2018.