# Frailty as a Predictor of Post-Traumatic Stress Disorder After Advance Care Planning Communication Intervention by Trained Care Managers in Long-Term Care Service Users in Japan: A Secondary Analysis

## TL;DR

Frailty in elderly care users is linked to higher stress after advance care planning conversations, suggesting personalized communication is needed.

## Contribution

This study identifies frailty as a novel predictor of post-traumatic stress disorder following advance care planning interventions.

## Key findings

- Users with a clinical frailty score ≥ 5 had significantly higher PTSD scores after ACP conversations.
- Logistic regression confirmed a strong association between higher frailty scores and increased PTSD symptoms.
- Cluster analysis groups showed consistent results, reinforcing the relationship between frailty and stress.

## Abstract

Background/Objectives: Advance care planning is essential in a community; however, intervention studies by care managers remain scarce. This study aims to determine the relationship between frailty and post-traumatic stress disorder among long-term care service users (hereinafter referred to as “users”) following advance care planning conversations with their care managers. Methods: We conducted a secondary analysis using raw data from the Japanese University Hospital Medical Information Network Study No. 000048573, published on 23 September 2024. In this previous study, trained care managers provided advance care planning conversation interventions to 30 users. Care managers conducted a convenience sample of 30 mentally and physically stable users who were 65 years old or older, had a family member or healthcare provider assigned, and had never used ACP. Our analysis in the present study focuses on the Clinical Frailty Scale and Impact of Events Scale-Revised, both of which measure post-traumatic stress disorder. Results: The Impact of Events Scale-Revised score was significantly higher in users with a clinical frailty score ≥ 5 compared to those with a clinical frailty score < 5. Logistic regression analysis, using the Impact of Events Scale-Revised as the objective variable, also revealed an association between a clinical frailty score ≥ 5 and a higher Impact of Events Scale-Revised. The four groups, selected through hierarchical cluster analysis for sensitivity analysis, demonstrated results consistent with the above analysis. Conclusions: The degree of post-traumatic stress disorder among users is associated with their degree of frailty following an advance care planning conversation with their care manager. Frailty in users may be a valuable predictor of stress related to advance care planning conversations. Users with a clinical frailty scale score ≥ 5 can be provided with more personalized care through more careful communication. University Hospital Medical Information Network Trial ID: 000048573.