HealthDay News —l The majority of older homeless-experienced adults have a potential surrogate for health care decisions, but few have discussed or documented their advance care planning (ACP) wishes, according to a study published in the June issue of the Journal of the American Geriatrics Society.

Rebecca L. Sudore, MD, 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% male and 82.1% black) in Oakland, Calif.

The researchers found that 61% of study participants reported a potential surrogate, 21.5% had discussed ACP, and 19% reported ACP documentation. Higher odds of ACP discussions were seen with having one to five confidants vs none (adjusted odds ratio [aOR], 5.8; 95% confidence interval (CI), 1.7 to 20), three or more chronic conditions vs none (aOR, 2.3; 95% CI, 0.9 to 5.6), and a recent primary care visit (aOR, 2.1; 95% CI, 1.0 to 4.4). Lower odds of ACP discussions were seen for each additional five years of homelessness (aOR, 0.7; 95% CI, 0.5 to 0.9). There were higher odds of ACP documentation with having one to five confidants (aOR, 5; 95% CI, 1.4 to 17.5), being black (aOR, 5.5; 95% CI, 1.5 to 19.5), and having adequate vs limited literacy (aOR, 7; 95% CI, 1.5 to 32.4). Illicit drug use was associated with lower odds of ACP documentation (aOR, 0.3; 95% CI, 0.1 to 0.9).

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“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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