Few older homeless adults make advance care plans
Rebecca L. Sudore, M.D., from the University of California in San Francisco, and colleagues assessed the prevalence of potential surrogate decision-makers, ACP contemplation, discussions, and ACP documentation (surrogate designation, advance directives) among 350 homeless-experienced adults aged 50 and older (75.2 percent male and 82.1 percent black) in Oakland, Calif.
The researchers found that 61 percent of study participants reported a potential surrogate, 21.5 percent had discussed ACP, and 19 percent reported ACP documentation. Higher odds of ACP discussions were seen with having one to five confidants versus none (adjusted odds ratio [aOR], 5.8; 95 percent confidence interval (CI), 1.7 to 20), three or more chronic conditions versus none (aOR, 2.3; 95 percent CI, 0.9 to 5.6), and a recent primary care visit (aOR, 2.1; 95 percent CI, 1.0 to 4.4). Lower odds of ACP discussions were seen for each additional five years of homelessness (aOR, 0.7; 95 percent CI, 0.5 to 0.9). There were higher odds of ACP documentation with having one to five confidants (aOR, 5; 95 percent CI, 1.4 to 17.5), being black (aOR, 5.5; 95 percent CI, 1.5 to 19.5), and having adequate versus limited literacy (aOR, 7; 95 percent CI, 1.5 to 32.4). Illicit drug use was associated with lower odds of ACP documentation (aOR, 0.3; 95 percent CI, 0.1 to 0.9).
"Future interventions must be customized for individuals with limited social networks and address the instability of homelessness, health literacy, and the constraints of safety-net health care settings," write the authors.
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