Advance Care Planning, Race, and Age

Topic: Risk, prevention and care in population studies

There are well-documented racial disparities in the provision of end-of-life care and advance care planning (ACP). It is unclear whether these observed disparities are explained by other variables. This analysis sought to determine whether any apparent racial disparities among general medicine inpatients in the provision of ACP services persisted after adjustment for potential confounders. The authors conducted a secondary analysis of electronic health records data collected as baseline data for a quality improvement program. The analysis included all patients who were discharged by hospitalists at an academic medical center from 4 general medicine inpatient units from July 2022 to June 2023, and who were identified as having limited life expectancy. The independent variables were demographic and clinical characteristics. The dependent variable was a composite of 4 ACP process measures (palliative care consultation, hospice discharge, comfort care status, or ACP note). Poisson regression was used to determine the association between patient characteristics and any ACP service. The analysis included 580 hospitalizations for 552 eligible patients. Patients had an average age of 73.8 years (SD 17.1), 54.5% were female, 51.3% were non-Hispanic White, 74.6% had Medicare, 43.8% had cancer, 20.5% had dementia, and 7.8% had heart failure. In unadjusted analyses, non-Hispanic Black patients were less likely to receive ACP services. However, when adjusted for age, sex, insurance, and medical conditions, the apparent racial disparity did not persist. To accurately assess health disparities in the context of quality improvement, adjustment for potential confounders may be needed.

Key findings

• The analysis included 580 hospitalizations for 552 eligible patients.
• Patients had an average age of 73.8 years (SD 17.1), 54.5% were female, 51.3% were non-Hispanic White, 74.6% had Medicare, 43.8% had cancer, 20.5% had dementia, and 7.8% had heart failure.
• In unadjusted analyses, non-Hispanic Black patients were less likely to receive ACP services.
• However, when adjusted for age, sex, insurance, and medical conditions, the apparent racial disparity did not persist.
• To accurately assess health disparities in the context of quality improvement, adjustment for potential confounders may be needed.

Why it matters

This analysis of hospital records found that an apparent racial disparity in receiving advance care planning services did not persist after adjusting for age, sex, insurance and medical conditions. It concerns equity in end-of-life care delivery, not treating, curing or preventing Alzheimer's disease.

Study details

• Participants580
• Effect size54.5%; 51.3%; 74.6%
• Evidence strengthLow

Read the original

• DOI: 10.1097/jmq.0000000000000285
• PubMed: 41705869
• Original source →
• Free full text: American Journal of Medical Quality →

Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).

@article{berger2026-41705869,
  author  = {Berger, Rebecca E. and Safford, Monika M. and Lee, Jennifer Inhae and Rajan, Mangala and McNairy, Margaret L. and Card, Andrea and Kern, Lisa M.},
  title   = {{Advance Care Planning, Race, and Age}},
  journal = {American Journal of Medical Quality},
  year    = {2026},
  doi     = {10.1097/jmq.0000000000000285},
  pmid    = {41705869},
  url     = {https://doi.org/10.1097/jmq.0000000000000285}
}

Studies this one cites

Referenced by this study and also in the alzhub library, so you can read them here.

• Evaluation of Racial Disparities in Hospice Use and End-of-Life Treatment Intensity in the REGARDS Cohort JAMA network open · 2020-08-03 · usefulness score 69/100 · Disparities
• Racial and Ethnic Differences in Hospice Use and Hospitalizations at End-of-Life Among Medicare Beneficiaries With Dementia JAMA network open · 2022-06-01 · usefulness score 69/100 · Disparities

Related studies in End-of-life care

• Race-Specific Impact of Telehealth Advance Care Planning on Cost of Dementia: A Cost Prediction Study International Journal of Environmental Research and Public Health · 2025-09-07 · usefulness score 41/100
• Advance care planning for older adults with advanced dementia living at old age homes- perspective of the surrogates Archives of Gerontology and Geriatrics Plus · 2025-02-28 · usefulness score 31/100
• Disease and Race‐Based Differences in Inpatient Palliative Care Consultation in Cancer and Noncancer Serious Illnesses Journal of the American Geriatrics Society · 2025-05-07 · usefulness score 53/100
• End-of-life care in general practice: A cross-sectional, retrospective survey of 'cancer', 'organ failure' and 'old-age/dementia' patients Palliative medicine · 2014-03-18 · usefulness score 57/100
• Dying comfortably in very old age with or without dementia in different care settings - a representative "older old" population study BMC geriatrics · 2017-10-05 · usefulness score 53/100
• Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia Journal of the American Geriatrics Society · 2019-11-21 · usefulness score 69/100

Similar studies

• Advance care planning: the future 2021 · End-of-life care
• Advance care planning: preferences for care at the end of life 2004 · End-of-life care
• Advance care planning and hospital in the nursing home 2006 · End-of-life care
• Advance care planning for people with dementia 2026 · End-of-life care
• Advance care planning in people with early cognitive impairment 2015 · End-of-life care
• Advance Care Planning in Cognitively Impaired Older Adults 2018 · End-of-life care

More on End-of-life care

• A review that covers this ground Alzheimer's disease, amnestic mild cognitive impairment, and age-associated memory impairment: current understanding and progress toward integrative prevention Alternative medicine review : a journal of clinical therapeutic · 2008-06-01 · usefulness score 43/100
• Newest in this subject Patient-Reported Shared Decision-Making and Documented Advance Care Planning Among Adults With Alzheimer’s Disease and Related Dementias medRxiv · 2026-10-19 · Preprint — not yet peer-reviewed · usefulness score 16/100
• Newest in this subject Perceived Barriers for Advance Care Planning Among People with Dementia and Family Caregivers: A Systematic Review of Qualitative Studies Preprints.org · 2026-10-07 · Preprint — not yet peer-reviewed · usefulness score 16/100

See all studies in End-of-life care →