Advance care planning among culturally and linguistically diverse older people in residential aged care

An article written by Dr Minah Gaviola, Lecturer, University of Newcastle

Older people in residential aged care facilities are mostly in the old-old (85+ years), with high care needs, and living with non-curable chronic illnesses (e.g. dementia) which may impact their decision-making capacity.  As such, advance care planning (ACP) is particularly important in ensuring that the care they receive at any stage of their illnesses is in accordance with their wishes and preferences. Considering the cultural diversity of Australia’s older people population, the ACP process should take into consideration the person’s cultural beliefs and practices and the ACP documentation should encompass culture-specific information.   However, there are barriers that may affect ACP engagement among older people from culturally and linguistically diverse (CALD) backgrounds. For example, in some Asian cultures, older people could play a passive role in decision making and rely on family or doctors to make decisions regarding their care [1]. Additionally, talking about death could be considered a taboo; thus, discussing plans for future care when the older person’s condition deteriorates or when they are approaching end of life could hamper their ACP engagement [1].

In recent years, there has been an increasing focus on cultural considerations in ACP. For example, the Advanced Care Planning: Aged Care Implementation Guide recommends that specific information related to engaging people from CALD and Indigenous backgrounds must be included in the ACP policy documents. The final draft of the Strengthened Aged Care Safety and Quality Standards requires aged care providers to implement ACP process in line with the person’s beliefs, cultural and religious practices, and traditions. While these recommendations underscore the cultural aspect of ACP, there is a lack of consensus on how cultural considerations are optimally integrated in the routine ACP practices.

In terms of research, there is insufficient evidence on the nature of ACP processes and documentation among people from CALD backgrounds in the residential aged care settings that could be used to inform ACP practices. Thereby, our team conducted a pilot study which explored ACP documentation related to the cultural needs of older residents of Chinese ethnicity from two residential aged care facilities in New South Wales [2].  Our findings showed that most of the residents had an ACP completed. Presence of the resident and/or their family during ACP completion and health care directives (e.g. cardiopulmonary resuscitation, treatment, hospital transfer) were well documented. However, there was limited documentation of culture specific information that should be considered in care provision. While documentation of the treatments and care that the resident would like to receive or refuse is highly valuable, inclusion of culture-specific information is equally important in the context of holistic and person-centred care.

There is a need for future research that develops and evaluates best practice guidelines on integrating culture-specific information in the ACP policy, process, and documentation in residential aged care. Care providers must ensure that the resident and/or their family have a good understanding of the process and the value of their active engagement in ACP discussion. There is a need to explore a culturally tailored approach to educating and engaging the CALD resident and their family. Also, as healthcare professionals (e.g. registered nurses, general practitioners) play a pivotal role in ACP, aged care providers must ensure that they receive adequate education on cultural beliefs and practices that may impact ACP engagement as well as culturally sensitive communication and approaches when initiating and discussing ACP.

In conclusion, there is a strong advocacy on the need to include cultural considerations in ACP. However, there is more work to be done to address the lack of clear guidelines and evidence on a culturally sensitive ACP in the residential aged care settings.

Authors

Dr Minah Gaviola, Lecturer (Nursing Older Person, Aged Care)

College of Health, Medicine and Wellbeing/School of Nursing and Midwifery

The University of Newcastle

Reference

1. Cheng S-Y, Lin C-P, Chan HY-l, Martina D, Mori M, Kim S-H, et al. Advance care planning in Asian culture. Jpn J Clin Oncol. 2020.

2. Gaviola MA, Pedzisi S, Inder KJ, Johnson A. Advanced care plan among older Chinese in residential aged care: A retrospective review. J Transcult Nurs. 2024.