Advance care planning among older Canadians amid the COVID-19 pandemic: a focus on sexual orientation.

OBJECTIVES: The COVID-19 pandemic has led to death and hardship around the world, and increased popular discourse about end-of-life circumstances and conditions. The extent to which this discourse and related pandemic experiences have precipitated advance care planning (ACP) activities was the focus of this study with a particular emphasis on sexual orientation. METHODS: A large, national online survey was conducted between 10 August and 10 October 2020 in Canada. The final sample of 3923 persons aged 55 and older was recruited using social media, direct email, and Facebook advertising and in conjunction with community groups. Women comprised almost 78% of the sample; just more than 7% of the sample identified as lesbian, gay, and bisexual (LGB). Measures included demographic variables and a series of questions on ACP, including documents and discussions undertaken prior to the pandemic and since its onset. RESULTS: Descriptive analyses revealed few gender or sexual orientation differences on documents and discussions prior to the pandemic; since its onset, LGB persons have completed or initiated wills, powers of attorney, advance directives, representation agreements, and have engaged in ACP discussions in greater proportion than heterosexuals. Logistic regressions reveal the increased likelihood of pre-pandemic ACP engagement by age, gender (women), and education; since the pandemic onset, gender, education, and sexual orientation were predictive of greater ACP engagement. Care discussions were more likely undertaken by women and LGB persons since the pandemic most often with spouses, family, and friends, especially among LGB persons. DISCUSSION: Gender roles and previous pandemic experiences (HIV/AIDS, in particular) are implicated in this pattern of results; opportunities for educational interventions are considered.

Has the COVID-19 Pandemic Increased Advance Care Planning Discussions Held by Older Adults?

In an online survey exploring older Canadians’ experiences during the COVID-19 pandemic, 3989 respondents aged 55-99 indicated whether they had discussed their future care preferences and with whom, prior to and since the outbreak. Pre-pandemic, 62% had held such discussions;since the pandemic 43% did so, 11% for the first time. Rates were significantly higher among white respondents than among persons of color, women than men, and those 65+ than younger respondents. Respondents were most likely to have talked, respectively, with their spouse (58% before;40% since), family (35%;22%), and friends (12%;10%)—with higher rates for white, women and older respondents. Surprisingly, only 4% before and 2% since the pandemic had discussed their care preferences with a doctor. Initiation of some new discussions was encouraging but there were fewer than expected, perhaps due to denial, superstition, or disbelief of pandemic severity. Advance care planning remains an under-utilized resource.

COVID-19 and the Intersection of Race, Ethnicity, and Sexual Minority Status

The COVID-19 virus has caused millions of deaths and impaired physical and mental health and social disconnection for countless persons around the world;concomitantly, the pandemic has exposed and exacerbated the pervasive effects of racism and stigma experienced by Black, Indigenous, or People of Color (BIPOC) and other marginalized/stigmatized groups. This study adopts an intersectional perspective examining multiple marginalized identities (i.e., the combination of LGBTQ and BIPOC status) and COVID-19 pandemic health stressors. We report on data from an online survey (conducted between Aug 10 and Oct. 10, 2020) focusing on current experiences and future planning during the COVID-19 pandemic in Canada. LGBTQ respondents (n=415) indicated significantly higher levels of depression, loneliness, sadness, and isolation in comparison to heterosexuals (n=3916). Heterosexual white respondents (n=3446) reported significantly higher levels of acceptance in their community and reported greater happiness but also higher rates of feeling of isolation than heterosexual BIPOC heterosexuals (n=470) who reported significantly higher rates of feeling judged/shamed by others than the heterosexual white respondents. In contrast to our expectations, white LGBTQ respondents (n=366) reported significantly more depression, loneliness, anxiety, and sadness than their BIPOC LGBTQ peers (n=49). These findings are interpreted as reflecting a complex mix of the effects of marginalization (as experienced by LGBTQ persons in general), and privilege and relative deprivation (as experienced by heterosexual and LGBTQ white persons) along with resilience and the moderated expectations and experiences of BIPOC LGBTQ persons.

Older Adults and Family Discord or Violence During the COVID-19 Pandemic: Results of a Canada-Wide Survey

Child abuse and intimate partner violence rates are known to increase during and in the aftermath of disasters. Research on elder abuse during disasters, including the current pandemic, is limited. As part of an online survey that explored older Canadians’ current experiences and future care plans during the COVID-19 pandemic, we aimed to determine the prevalence, contributing factors and potential outcomes of frequent family discord involving physical violence (FFD/PV) as a proxy for elder abuse. The survey was conducted between Aug 10 and Oct 10, 2021. Respondents (n=4380) were recruited using social media, direct email, Facebook advertising and with the assistance of 85 local community, regional and national organizations. The sub-sample reporting FFD/PV (n=76, 1.8%) was compared with other survey respondents regarding socio-demographic characteristics, negative and positive emotions, difficulty accessing basic needs, food, health care and support. Respondents experiencing FFD/PV were found to be significantly younger and less educated and were more likely to be non-white and not working than other respondents. The subgroup sustaining FFD/PV reported significantly higher rates of feeling depressed, lonely, isolated, anxious, sad, and judged/shamed and felt less happy, relaxed and accepted in their community. They also reported higher rates of challenges in accessing basic material needs such as food, support, medical care, mental health treatment and experienced more changes in life routines. Although only a small percentage reported FFD/PV, our results highlight a disturbing pattern that merits serious attention of adult protection agencies, seniors' advocates and disaster response organizations.