Social support  is associated with the outcome of shared decision-making regarding treatment limitations. An observational study with older patients in the emergency department.

Background : Although advance care planning (ACP) and shared decision making (SDM) concerning treatment limitations are ideally conducted by long-term caregivers in a stable environment, in practice many older patients encounter these decisions in the emergency department (ED), making it essential to understand the factors associated with SDM outcomes in this context. Purpose : This study explores the impact of the psychological well-being, perspective, and needs in SDM regarding treatment limitations among older ED patients. Based on these findings, we aim to provide recommendations for ACP. Methods : A cross-sectional, observational study was conducted in the ED of a general hospital in the Netherlands. Patients aged 70 and older with indications for hospital admission were included. Participants completed questionnaires assessing anxiety (STAI-6), health locus of control (MHCLS), social support and satisfaction with SDM. Data on treatment limitations and frailty (APOP) were extracted from patient records. Associations between these variables and treatment limitations were analysed using multinomial regression. Results : Of 105 participants (mean age 80.07, 49.5% female), treatment limitations were recorded for 99 patients. Overall satisfaction with SDM was high. Regression analysis revealed no significant association between anxiety or health locus of control and treatment limitations. However, older age was negatively associated with treatment limitations (p < .001), while social support was associated with more comprehensive treatment limitations (p=0.0063). Conclusion : Age and social support show significant associations with SDM outcomes regarding treatment limitations in older ED patients. These findings highlight the importance of early ACP and involvement of supporting caregivers when discussing treatment limitations.