[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-427377-105":59,"doc-detail-427377-en":134},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":127,"head_meta":129,"extra_data":131,"updated_unix":133},105,"en","adherence-to-end-of-life-instructions-across-cognition-levels-insights-from-the-health-and-retirement-study","ADHERENCE TO END-OF-LIFE INSTRUCTIONS - Across Cognition Levels - Insights From the Health and Retirement Study","","Adherence to end-of-life instructions remains insufficiently studied and may differ across cognition levels in older adults. Cognitive decline can affect decision-making and the implementation of advance care planning. Using data from deceased participants in the Health and Retirement Study (1994–2018), adherence was assessed via proxy-reported difficulties following written EOL instructions, provider follow-through challenges, and unwanted treatment after refusal.",{"@graph":69,"@context":126},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/adherence-to-end-of-life-instructions-across-cognition-levels-insights-from-the-health-and-retirement-study/427377/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/adherence-to-end-of-life-instructions-across-cognition-levels-insights-from-the-health-and-retirement-study/427377.png","ImageObject",300,407,{"name":92,"@type":93},"Liam","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-10","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118,122],{"name":109,"@type":110,"acceptedAnswer":111},"What is the study’s main goal regarding end-of-life instruction adherence?","Question",{"text":112,"@type":113},"To examine how adherence to end-of-life instructions varies across different cognition levels in older adults.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was adherence to end-of-life instructions measured in the study?",{"text":117,"@type":113},"Adherence was measured using three proxy-based indicators: difficulties following written EOL instructions, healthcare provider difficulties following written instructions, and instances of unwanted treatment despite family or decision-maker refusal.",{"name":119,"@type":110,"acceptedAnswer":120},"What were the study’s key findings for participants with dementia?",{"text":121,"@type":113},"Individuals with dementia were more likely to receive unwanted treatment despite refusal; the dementia group had an odds ratio of 2.37 compared with normal cognition participants.",{"name":123,"@type":110,"acceptedAnswer":124},"Why do the authors say improved communication is needed?",{"text":125,"@type":113},"Because disparities in adherence suggest end-of-life preferences may not be honored consistently, requiring better communication among those involved and strategies to ensure preferences are respected across cognition levels.","https://schema.org",{"og:url":83,"og:type":128,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":130,"canonical":83},"index,follow",{"doc_id":132,"site_id":62},427377,1791102280,{"code":4,"msg":5,"data":135},{"doc_id":132,"user_id":136,"nickname":92,"user_avatar":137,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":138,"file_id":139,"file_url":140,"file_type":141,"file_size":142,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":143,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":144,"faqs":145,"seo_title":146,"seo_description":67,"update_tm":147,"read_time":81},8796095461564,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Innovation in Aging, 2025, Vol. 9, No. S2 765  \nSESSION 7220 (POSTER)   \nEND-OF-LIFE  \nAbstract citation ID: igaf122.2599  \nADHERENCE TO END-OF-LIFE INSTRUCTIONS  \nACROSS COGNITION LEVELS: INSIGHTS FROM THE  \nHEALTH AND RETIREMENT STUDY  \nZahra Rahemi1, Juanita-Dawne Bacsu2, and Swann Adams3, 1.  \nClemson University, Clemson, South Carolina, United States, 2. Thompson Rivers University, Kamloops, British Columbia, Canada, 3. University of South Carolina, Columbia, South Carolina, United States  \nAdherence to end-of-life instructions is understudied and may vary across cognition levels in older adults, as cognitive decline can impact decision-making and the implementation of advance care planning. This study aims to examine adherence to end-oflife instructions across different cognition levels in older adults.  \nData from deceased participants in the Health and Retirement Study (HRS, 1994–2018) were extracted using exit files to assess adherence to end-of-life instructions. Langa Weir classification was used for cognition categorization. Adherence was measured using three indicators: proxy-reported difficulties in following written EOL instructions, proxy-reported healthcare provider difficulties in following written instructions, and instances where the patient received unwanted treatment despite family or decision-maker refusal. Individuals with dementia and impaired cognition were older at death, less likely to be married, more likely to have a high school education or less, and predominantly female. They were less likely to discuss end-of-life care prior to death or have a living will at death (p \u003C 0.05) and marginally less likely to want all possible care (p = 0.06) . Regarding adherence indicators, dementia group participants were 2.37 times more likely to receive unwanted treatment despite family/ decision-maker refusal compared to normal cognition participants (OR = 2.37 [95% CI: 1.04–5.40], p \u003C 0.05) . Our findings highlight disparities in adherence to end-of-life instructions, with individuals with dementia being more likely to receive unwanted treatment. These results underscore the need for improved communication between individuals involved in end-of-life care and strategies to ensure that end-of-life preferences are honored across cognition levels.","cbCaifKvxVyWkwRQ","https://ap.wps.com/l/cbCaifKvxVyWkwRQ","pdf",698970,"English","# Abstract\n## Study Purpose\n## Data and Measures\n## Participant Characteristics\n## Key Findings\n## Implications","[{\"question\":\"What is the study’s main goal regarding end-of-life instruction adherence?\",\"answer\":\"To examine how adherence to end-of-life instructions varies across different cognition levels in older adults.\"},{\"question\":\"How was adherence to end-of-life instructions measured in the study?\",\"answer\":\"Adherence was measured using three proxy-based indicators: difficulties following written EOL instructions, healthcare provider difficulties following written instructions, and instances of unwanted treatment despite family or decision-maker refusal.\"},{\"question\":\"What were the study’s key findings for participants with dementia?\",\"answer\":\"Individuals with dementia were more likely to receive unwanted treatment despite refusal; the dementia group had an odds ratio of 2.37 compared with normal cognition participants.\"},{\"question\":\"Why do the authors say improved communication is needed?\",\"answer\":\"Because disparities in adherence suggest end-of-life preferences may not be honored consistently, requiring better communication among those involved and strategies to ensure preferences are respected across cognition levels.\"}]","ADHERENCE TO END-OF-LIFE INSTRUCTIONS - Across Cognition Levels - Insights From the Health and Retirement Study | PDF",1790643678]