Background The discourse surrounding advance care planning (ACP) has evolved from an emphasis on a ‘legal, transactional’ approach to incorporate a ‘communications approach’. This dual emphasis has led to confusion about meaning, reflected in debates internationally. Some merge ACP with patient and family centred care; others focus on planning for incapacity and medical decision-making. A number of contemporary definitions bridge the two approaches. Generally, ACP debates are poorly informed by evidence about patients’ preferences for modes of ACP or their understandings about the meaning of ACP.
Aim To examine the experiences and understandings of older people and distill the implications of these for the practice of ACP with frail older people.
Methods This presentation reports a synthesis of findings from a qualitative research programme with older people. The studies include participants classically considered to belong to ‘minority’ groups, such as black and minority ethnic groups, lesbian, gay and bisexual elders and those in very late old age.
Results The presentation necessarily briefly examines cultural, practical and existential issues associated with ‘future’ oriented planning expressed by older people across several studies.
Discussion Frail older people draw on biographical experiences of bereavement and provision of end-of life care for others, as well as expressing their expectations and concerns for their own care, when considering the meaning of ACP.
Conclusion Although ACP has particular salience for frail older people, given the profound difficulties they face in accessing supportive care, ACP tends to take poor account of the ‘lived’ worlds of frailty.
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