A majority of older adults prefer to remain independent in their homes as they age, referred to as aging in place. As adults age in place, it is essential that they develop appropriate plans to address their shifting health needs and future care. Advance Care Planning supports aging in place and allows older adults to plan for their future care in the event that they are unable to make their own decisions. With advanced care planning, older adults can be proactive about their health, reduce caregiver burden, and improve their quality of life. Part of advance care planning is completing advance care directives which are legal documents that record your wishes for any medical treatment and care based on your personal and cultural values. The most widely recognized directives are a living will, power of attorney, health care proxy, and do not resuscitate orders (DNRs).
There are several options to begin advance care planning and it often requires having some difficult conversations with family or medical providers. Many Medicare beneficiaries are unaware that advance care planning is fully covered when billed by a physician as part of yearly wellness visits (and only the usual 20% cost-sharing if done outside of the wellness visit).
Many older adults begin thinking about their future care preferences but never legally formalize any of these plans. Despite the medical and legal benefits of having formalized directives, studies have shown that only 1 in 3 Americans completes any type of advance care directive and uptake for those who need it most remains low. There are many associated barriers for both healthcare professionals and patients like deciding when is the best time to start advance care planning. Additional barriers to advance care planning are:
- Accessibility including language and internet access
- Knowledge and awareness of advance care planning directives
- Lack of family support and views on life sustaining treatments
- Cognitive impairments
- Infrequent medical visits or no established primary doctor
Technology can increase accessibility and uptake of advance care planning while being cost-effective. Online, older adults can learn more about end of life care at their own pace and educational level, and in their preferred language. Technology can also encourage those that live alone to remain connected and include family in the care planning process. Furthermore, for those with mobility issues, it reduces transportation barriers to visiting physicians and discussing advance care planning.
Most states and US territories have advance care planning documents available online for download and completion. Many hospitals throughout the country now allow patients to directly upload formalized directives to their charts. Technology has expanded the ways older adults can approach and complete advance care planning, yet the low adoption rate shows there is still opportunity for innovation. Most recently, this innovation has been displayed by the creation of several advance care planning apps, such as MyDirectives MOBILE and CARE-IT.
Additionally, since advance care planning is an ongoing process that can change over time, technology enables patients and providers to track completion of advance care directives while having continued access to make future changes. Advance care planning ensures that older adults receive care that supports their decisions to age in the manner they prefer all while supporting families through difficult care decisions.