SAFE PLACE: Sorting Age-Friendly Environment Factors of Planning in Advance for Care A multi-methods study exploring environmental indicators of advance care planning among low-income, older adults

Abstract

Advance care planning refers to the ongoing, iterative process of health behavior change with the goal of full participation with end-of-life care planning exhibited by routine behaviors of formal and informal documentation and discussion of wishes. Despite benefits such as improved clinician-patient communication and improved quality of care at the end of life, overall advance care planning rates are low (50%) and even lower among low socioeconomic status older adults (20-30%). While psychosocial factors (e.g., health literacy) and community-level factors (e.g., neighborhood socioeconomic status) have been studied with advance care planning, specific, perceived community resources have not been explored. The perceived environment is the conscious interaction of individuals with the actual environment (i.e., social and physical resources) through sensory uptake. The World Health Organization’s Age-Friendly Environment initiative and framework consists of eight age-friendly resources that support healthy aging and equitable health participation among older adults. In this multi-methods study, we described Age-Friendly Environment factors and advance care planning readiness among low-income older adults and described associations (Chapter 2). Additionally, we explored life-course experiences of Age-Friendly Environment factors and advance care planning (Chapter 3). Lastly, we explored daily life experiences of COVID-19 and its impact on end-of-life views (Chapter 4). We conclude this report by summarizing the results and describing next steps for the program of research and implications of findings.