Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 1;64(7):gnae059.
doi: 10.1093/geront/gnae059.

Using the Age-Friendly Environment Framework to Assess Advance Care Planning Factors Among Older Adults With Limited Income: A Cross-Sectional, Descriptive Survey Study

Christine Cleary Kimpel  1 , Mary S Dietrich  1   2 , Jana Lauderdale  1 , David G Schlundt  3 , Cathy A Maxwell  1
Affiliations

Using the Age-Friendly Environment Framework to Assess Advance Care Planning Factors Among Older Adults With Limited Income: A Cross-Sectional, Descriptive Survey Study

Christine Cleary Kimpel et al. Gerontologist. .

Abstract

Background and objectives: The World Health Organization created the Age-Friendly Environment (AFE) framework to design communities that support healthy aging and equitable decision making. This framework's resource domains may account for disparately lower advance care planning (ACP) among older adults with limited incomes compared to those with high incomes. We aimed to describe and examine associations of AFE factors with ACP.

Research design and methods: We recruited and conducted cross-sectional surveys among older adults with limited incomes in 7 community-based settings in Nashville, TN. ACP and AFE item scales were dichotomized and analyzed with unadjusted phi correlation coefficients.

Results: Survey participants (N = 100) included 59 women, 70 Black/African American, and 70 ≥60 years old. Most participants agreed that their community was age friendly (≥58%) and varied in ACP participation (22%-67%). Participants who perceived easy travel and service access and sufficient social isolation outreach were more likely to have had family or doctor quality-of-life discussions (phi = 0.22-0.29, p < .05). Having a healthcare decision maker was positively associated with age-friendly travel, housing, and meet-up places (phi = 0.20-0.26, p < .05).

Discussion and implications: The AFE framework is useful for exploring the environmental factors of ACP, but further research is warranted to identify specific and immediate resources to support successful ACP among populations with socioeconomic disadvantage.

Keywords: Aging; Future care planning; Perceived environment; Questionnaire; Socioeconomic status.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Figure 1.
Figure 1.
Age-friendly environment assessment tool dichotomized item distributions (%) (N = 100).
Figure 2.
Figure 2.
Advance care planning instrument dichotomized item distributions (%) (N = 100).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Ashana, D. C., D’Arcangelo, N., Gazarian, P. K., Gupta, A., Perez, S., Reich, A. J., Tjia, J., Halpern, S. D., Weissman, J. S., & Ladin, K. (2022). “Don’t talk to them about goals of care”: Understanding disparities in advance care planning. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 77(2), 339–346. 10.1093/gerona/glab091 - DOI - PMC - PubMed
    1. Aubry, T., Bloch, G., Brcic, V., Saad, A., Magwood, O., Abdalla, T., Alkhateeb, Q., Xie, E., Mathew, C., Hannigan, T., Costello, C., Thavorn, K., Stergiopoulos, V., Tugwell, P., & Pottie, K. (2020). Effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in high-income countries: A systematic review. Lancet Public Health, 5(6), e342–e360. 10.1016/S2468-2667(20)30055-4 - DOI - PubMed
    1. Barwise, A., Juhn, Y.J., Wi, C.-I., Novotny, P., Jaramillo, C., Gajic, O., & Wilson, M.E. (2019). An individual housing-based socioeconomic status measure predicts advance care planning and nursing home utilization. American Journal of Hospital & Palliative Care, 36(5), 362–369. 10.1177/1049909118812431 - DOI - PMC - PubMed
    1. Benson, C. (2023). Child poverty rate still higher than for older populations but declining. United States Census Bureau. https://www.census.gov/library/stories/2023/12/poverty-rate-varies-by-ag...
    1. Bezyak, J. L., Sabella, S., Hammel, J., McDonald, K., Jones, R. A., & Barton, D. (2020). Community participation and public transportation barriers experienced by people with disabilities. Disability and Rehabilitation, 42(23), 3275–3283. 10.1080/09638288.2019.1590469 - DOI - PubMed

Publication types