INTRODUCTIONRecommendations for advance care planning (ACP) in persons with cognitive impairment are based on expert input without insight from actual ACP conversations.METHODSWe used thematic analysis to analyze transcripts of ACP conversations for 88 older adults with normal cognition (n = 15), mild cognitive impairment (n = 13), and scores consistent with dementia (n = 60).RESULTSPatients with dementia were least verbally active; however, some shared values and identified surrogates. We identified three themes: (1) cognitive impairment inhibits participation in ACP, but individuals with dementia are able to contribute; (2) care partners have a key role in supporting ACP across the spectrum of cognitive impairment; and (3) structured questions about values and tailored communication strategies can facilitate engagement of older adults with dementia.DISCUSSIONOur findings reinforce best practice recommendations for early ACP and identify strategies to increase patient engagement among older adults with cognitive impairment with support of care partners.Highlights Data from actual ACP conversations involving older adults with a range of cognitive function and their care partners reinforce best practice recommendations and suggest practical implications for education and training. Family involvement in ACP was valued by older adults and improved engagement. ACP initiatives should prioritize eliciting values of older adults with dementia and improving skills for communication to increase engagement.

中文翻译：

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80 岁及以上认知障碍成年人的预先护理计划：使用实际对话来检查最佳实践


引言认知障碍患者预先护理计划 （ACP） 的推荐基于专家的意见，而没有来自实际 ACP 对话的见解。方法我们使用主题分析来分析 88 名认知正常 （n = 15）、轻度认知障碍 （n = 13） 和与痴呆一致的分数 （n = 60） 的老年人的 ACP 对话记录。结果患有痴呆的患者语言最不活跃;然而，一些人有共同的价值观和确定的代理人。我们确定了三个主题：（1） 认知障碍抑制参与 ACP，但痴呆个体能够做出贡献;（2） 护理伙伴在支持认知障碍范围内的 ACP 方面发挥着关键作用;（3） 关于价值观和量身定制的沟通策略的结构化问题可以促进患有痴呆的老年人的参与。讨论我们的研究结果加强了早期 ACP 的最佳实践建议，并确定了在护理伙伴的支持下提高认知障碍老年人患者参与度的策略。亮点 涉及具有一系列认知功能的老年人及其护理伙伴的实际 ACP 对话的数据强化了最佳实践建议，并提出了对教育和培训的实际意义。老年人重视家庭参与 ACP 并提高参与度。ACP 倡议应优先考虑激发患有痴呆症的老年人的价值，并提高沟通技巧以提高参与度。