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Factors Associated with Having a Will, Power of Attorney, and Advanced Healthcare Directive in Patients Presenting to a Rural and Remote Memory Clinic

  • Sydney Lee (a1), Andrew Kirk (a2), Emily A. Kirk (a3), Chandima Karunanayake (a4), Megan E. O’Connell (a5) and Debra Morgan (a4)...

Abstract:

Background: A Will, Power of Attorney, and Advanced Healthcare Directive are critical to guide decision-making in patients with dementia. We identified characteristics that are associated with the existence of these documents in patients who presented to a rural and remote memory clinic (RRMC). Methods: Ninety-five consecutive patients were included in this study. Patients and caregivers completed questionnaires on initial presentation to the RRMC and patients were asked if they had legal documents. Patients also completed neuropsychological testing. Statistical analysis (t-test and χ2 test) was performed to identify significant variables. Results: Seventy (73.7%) patients had a Will, 62 (65.3%) had a Power of Attorney, and 21 (22.1%) had an Advanced Healthcare Directive. Having a Will was associated with good quality of life (p = 0.001), living alone or with a spouse or partner only (p = 0.034), poor verbal fluency (p = 0.055), and European ethnicity (p = 0.028). Factors associated with having a Power of Attorney included good quality of life (p = 0.031), living alone or with a spouse or partner only (p = 0.053), and poor verbal fluency (p = 0.015). Old age (p = 0.015), poor verbal fluency (p = 0.023), and greater severity of cognitive and functional impairment (p = 0.023) were associated with having an Advanced Healthcare Directive. Conclusions: Our results indicate that poor quality of life, good performance on verbal fluency, Indigenous ethnicity, and living with others are associated with a lower likelihood of legal documents in patients with dementia. These factors can help physicians identify patients at risk of leaving their legal affairs unattended to. Physicians should discuss the creation of legal documents early on in patients with signs of dementia.

Quels sont les facteurs associés au fait d’avoir un testament, une procuration et des directives médicales anticipées dans le cas de patients s’étant présentés à une clinique située en région rurale et éloignée ?Contexte: Un testament, une procuration et des directives médicales anticipées sont essentiels pour orienter la prise de décision dans le cas de patients atteints de démence. À cet égard, nous avons tenté d’identifier les caractéristiques associées à l’existence de ces documents légaux chez des patients s’étant présentés à une clinique située en région rurale et éloignée. Méthodes: Au total, 95 patients vus consécutivement ont été inclus dans cette étude. Ces patients, de même que leurs proches aidants, ont complété un questionnaire dès leur arrivée dans cette clinique. En plus de faire subir des tests neuropsychologiques aux patients, on leur a aussi demandé s’ils comptaient sur un des documents légaux cités précédemment. Pour identifier des variables significatives, nous avons effectué une analyse statistique au moyen des tests de Student et du χ2. Résultats: 70 patients (73,7 %) possédaient un testament ; 62 (65,3 %) avaient une procuration ; enfin, 21 (22,1 %) avaient établi des directives médicales anticipées. Le fait de posséder un testament a été associé à une bonne qualité de vie (p = 0,001), au fait de vivre seul ou en compagnie seulement d’un (e) conjoint (e) ou d’un (e) partenaire (p = 0,034), de montrer une faible fluidité verbale (p = 0,055) et de posséder des ancêtres d’origine européenne (p = 0,028). Maintenant, le fait de posséder une procuration a été associé aux facteurs suivants : une bonne qualité de vie (p = 0,031), vivre seul ou en compagnie seulement d’un (e) conjoint (e) ou d’un (e) partenaire (p = 0,053) et une faible fluidité verbale (p = 0,015). Enfin, ceux et celles ayant établi des directives médicales anticipées se sont révélés plus susceptibles d’être âgés (p = 0,015), d’être atteints d’une faible fluidité verbale (p = 0,023) et de montrer une déficience cognitive et fonctionnelle davantage prononcée (p = 0,023). Conclusions: Nos résultats indiquent qu’une piètre qualité de vie, qu’une élocution verbale aisée, que des origines autochtones et que le fait de partager sa vie avec plus d’une personne sont associés à une probabilité moindre de compter sur des documents légaux lorsqu’on est atteints de démence. Ces facteurs peuvent donc aider les médecins à repérer les patients à risque de négliger leurs affaires légales. À cet effet, les médecins devraient veiller à aborder très tôt la rédaction de ces documents avec des patients qui manifestent des symptômes de démence.

Copyright

Corresponding author

Correspondence to: Sydney Lee, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada. Email: sal052@mail.usask.ca

References

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1.Fiest, KM, Jetté, N, Roberts, JI, et al. The prevalence and incidence of dementia: a systematic review and meta-analysis. Can J Neurol Sci. 2016;43(S1):S3S50.
2.Charles, L, Parmar, J, Bremault-Phillips, S, Dobbs, B, Sacrey, L, Sluggett, B. Physician education on decision-making capacity assessment: current state and future directions. Can Fam Physician. 2017;63(1):e21e30.
3.Alzheimer Society of Canada. Prevalence and monetary costs of dementia in Canada. Health Promot Chronic Dis Prev Can. 2016;36(10):231–2.
4.American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
5.Voskou, P, Douzenis, A, Exonomou, A, Papageorgiou, SG. Testamentary capacity assessment: legal, medical, and neuropsychological issues. J Geriatr Psychiatry Neurol. 2018;31(1):312.10.1177/0891988717746508
6.Burla, C, Rego, G, Nunes, R. Alzheimer, dementia and the living Will: a proposal. Med Health Care Philos. 2014;17(3):389–95.
7.The Wills Act of 1996, S. 21, Ch. W-14.1, Statutes of Saskatchewan (August 1, 1997).
8.Banks v. Goodfellow, L.R. 5, Q.B. 549 (1870).
9.Parker v. Felgate, L.R. 8, P.D. 171 (Eng P.D.A.) (1883).
10.Intestate Succession Act of 1996, S. 6, Ch. I-13.1, Statutes of Saskatchewan (November 1, 1996).
11.Substitute Decisions Act of 1992, S. 7, S.46, Ch. 30, Statutes of Ontario (May 7, 2018).
12.Health Care Directives and Substitute Decision Health Care Decision Makers Act of 2015, S. 2(1)(b)-4, 16(1), 16(4), 17, Ch. H-0.002, Statutes of Saskatchewan (February 15, 2017).
13.Hewson, T. Number of Canadians without Wills significantly under-reported. Canadian Legal Wills; 2016. Available at: https://www.legalWills.ca/blog/canadians-without-Wills/. Accessed March 21, 2018.
14.Lawyers Professional Indemnity Company (LAWPRO). Survey: more than half of Canadians do not have a signed Will. 2012. Available at: http://www.lawpro.ca/news/pdf/Wills-POAsurvey.pdf. Accessed March 21, 2018.
15.Canadian Hospice Palliative Care Association. Fact sheet: hospice palliative care in Canada. 2014. Available at: http://www.chpca.net/media/330558/Fact_Sheet_HPC_in_CanadaSpring202014Final.pdf. Accessed March 21, 2018.
16.Elliot, D. The age distribution of the Saskatchewan population. Sask Trends Monitor. 2012;24:210.
17.Laurent, S. Rural Canada: access to health care. Ottawa: Parliamentary Research Branch; 2002.
18.Crossley, M, Morgan, D, Lanting, S, Dal Bello-Haas, V, Kirk, A. Interdisciplinary research and interprofessional collaborative care in a memory clinic for rural and northern residents of western Canada: unique training ground for clinical psychology graduate students. Aust Psychol. 2008;43:231–8.
19.McEachern, W, Kirk, A, Morgan, DG, Crossley, M, Henry, C. Reliability of the MMSE administered in-person and by telehealth. Can J Neurol Sci. 2008;35:643–6.
20.Morgan, DG, Crossley, M, Kirk, A, et al. Improving access to dementia care: development and evaluation of a rural and remote memory clinic. Aging Mental Health. 2009;13:1730.10.1080/13607860802154432
21.Verity, R, Kirk, A, O’Connell, ME, Karunanayake, C, Morgan, DG. The worried well? Characteristics of cognitively normal patients presenting to a rural and remote memory clinic. Can J Neurol Sci. 2018;45(2):158–67.
22.Verity, R, Kirk, A, Morgan, D, Karunanayake, C. Trends in medication use over 11 years in patients presenting to a rural and remote memory clinic. Can J Neurol Sci. 2016;43(6):815–8.10.1017/cjn.2016.281
23.Hager, D, Kirk, A, Morgan, DG, Karunanayake, C, O’Connell, ME. Predictors of cognitive decline in a rural and remote Saskatchewan population with Alzheimer’s disease. Am J Alzheimers Dis Other Demen. 2016;31(8):643–9.10.1177/1533317516662334
24.Saleh, S, Kirk, A, Morgan, DG, Karunanayake, C. Less education predicts anticholinesterase discontinuation in dementia patients. Can J Neurol Sci. 2013;40(5):684–90.
25.Lacny, C, Kirk, A, Morgan, DG, Karunanayake, C. Predictors of cognitive impairment severity in rural patients at a memory clinic. Can J Neurol Sci. 2012;39(6):774–81.
26.Heggie, M, Morgan, D, Crossley, M, et al. Quality of life in early dementia: comparison of rural patient and caregiver ratings at baseline and one year. Dementia. 2012;11(4):521–41.
27.Lacny, C, Kirk, A, Morgan, DG, Karunanayake, C. Does day length affect cognitive performance in memory clinic patients? Can J Neurol Sci. 2011;38(3):461–4.
28.Steve, TA, Kirk, A, Crossley, M, et al. Medication use in patients presenting to a rural and remote memory clinic. Can J Neurol Sci. 2008;35(5):669–71.
29.Folstein, MF, Folstein, SE, McHugh, PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.
30.Radloff, LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385401.
31.Flanagan, JC. A research approach to improving our quality of life. Am Psychol. 1978;33:138–47.10.1037/0003-066X.33.2.138
32.Hughes, CP, Berg, L, Danziger, WL,Coben, LA, Martin, RL. A new clinical scale for the staging of dementia. Brit J Psychiatry. 1982;140:566–72.
33.Bucks, RS, Ashworth, DL, Wilcock, GK, Siegfried, K. Assessment of activities of daily living in dementia: development of the Bristol activities of daily living scale. Age Ageing. 1996;25:113–20.
34.Lawton, MP, Brody, EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179–86.
35.Pfeffer, RI, Kurosaki, TT, Harrah, CH Jr., Chance, JM, Filos, S. Measurement of functional activities in older adults in the community. J Gerontol. 1982;37(3):323–9.
36.Cummings, JL, Mega, M, Gray, K, Rosenberg-Thompson, S, Carusi, DA, Gornbein, J. The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44(12):2308–14.10.1212/WNL.44.12.2308
37.Delis, DC, Kaplan, E, Kramer, JH. Delis--Kaplan executive function system: technical manual. San Antonio, TX: Harcourt Assessment Company; 2001.
38.Wechsler, D. Administration and scoring manual for the Wechsler Memory Scale. 4th ed. San Antonio, TX: Pearson; 2009.
39.Delis, DC, Kramer, JH, Kaplan, E, Ober, BA. California verbal learning test: adult version manual. 2nd ed. San Antonio, TX: Psychological Corporation; 2000.
40.IBM Corporation. IBM SPSS statistics for Windows, version 24.0. Armonk, NY: IBM Corporation; 2016.
41.Fisk, JE, Sharp, CA. Age-related impairment in executive functioning: updating, inhibition, shifting, and access. J Clin Exp Neuropsychol. 2004;26(7):874–90.10.1080/13803390490510680
42.Shao, Z, Janse, E, Visser, K, Meyer, AS. What do verbal fluency tasks measure? Predictors of verbal fluency performance in older adults. Front Psychol. 2014;5:772.
43.Burke, DM, Shafto, MA. Aging and language production. Curr Dir Psychol Sci. 2004;13(1):21–4.
44.Dixon, RA, Hopp, GA, Cohen, AL, de Frias, CM, Backman, L. Self-reported memory compensation: similar patterns in Alzheimer’s disease and very old adult samples. J Clin Exp Neuropsychol. 2003;25(3):382–90.
45.Perry-Young, L, Owen, G, Kelly, S, Owens, C. How people come to recognise a problem and seek medical help for a person showing early signs of dementia: a systematic review and meta-ethnography. Dementia. 2018;17(1):3460.
46.Ahmed, S, Mitchell, J, Arnold, R, Dawson, K, Nestor, PJ, Hodges, JR. Memory complaints in mild cognitive impairment, worried well, and semantic dementia patients. Alzheimer Dis Assoc Disord. 2008;22(3):227–35.
47.Salthouse, TA. What cognitive abilities are involved in trail-making performance? Intelligence. 2011;39(4):222–32.
48.Aboriginal peoples: a fact sheet for Saskatchewan. Statistics Canada; 2016. Available at: http://www.statcan.gc.ca/pub/89-656-x/89-656-x2016009-eng.htm. Accessed May 12, 2018.
49.Wright, AC. Access to justice in indigenous communities: an intercultural strategy to improve access to justice. Canadian Research Institute for Law and the Family; 2017. Available at: http://www.crilf.ca/Documents/AccesstoJusticeinIndigenousCommunities-May2017.pdf. Accessed May 12, 2018.
50.Morse, BW. Native people and legal services in Canada. McGill Law J. 1976;22:517.
51.Salive, ME. Multimorbidity in older adults. Epidemiol Rev. 2013;35:7583.
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