Aim: To examine the association between frailty status and completion of advance care plans in older adults with stroke.
Method: A convenience sample of older adults with stroke enrolled in the Western Sydney Clinical Frailty Registry, with a 12-month follow-up completed. All types of stroke (both ischaemic and haemorrhagic) were included. Frailty was assessed using the Clinical Frailty Scale (CFS); 1-4 is ‘non-frail’, 5-6 is ‘mild-moderately frail’, and 7-9 is ‘severely frail’. The use of advance care plans was confirmed through documentation of advance care or resuscitation plans in the participant's electronic medical records. Binary logistic regression model was fitted to examine the association between frailty status and use of advance care plans.
Results: In a cohort of 356 older adults with stroke (mean age 82 years, 48% women), 43% (n=153) had advance care plan documentation. Within 12 months, 22% (n=79) had died, and among these 66% (n=52) had advance care planning documentation. Mild-moderately frail participants had almost two-fold higher odds of having advance care plan documentation than non-frail participants (OR:2.2, 95%CI 1.27 – 3.71). Severely frail participants had almost four times greater odds of having advance care plan documentation than non-frail participants (OR:3.85, 95%CI 1.9 – 7.7).
Conclusion: Higher frailty status was significantly associated with the completion of advanced care plans in adults with stroke. Advance care planning is an important activity for older adults with stroke and frailty to guide shared decision-making, care planning and treatment choices later in life.