Advance Directives and Outcomes of Surrogate Decision Making before Death

Bibliographic Data

ID23328754
AuthorsMaria J Silveira (0000-0002-6600-8633, University of Michigan), Scott Y H Kim (0000-0002-9444-4627, University of Michigan), Kenneth M Langa (0000-0002-2798-1836, University of Michigan)
Year2010
Volume362
Issue13
Pages1211-1218
Publication date2010-04-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueNew England Journal of Medicine (JOURNAL)
Journal identifiersISSN: 0028-4793 • E-ISSN: 1533-4406
PublisherMassachusetts Medical Society (PUBLISHER • US)
DOI10.1056/nejmsa0907901
PMID20357283
PMCIDPMC2880881
OpenAlexW2153738735
LanguageEN
Citations received76
References cited15

BACKGROUND: Recent discussions about health care reform have raised questions regarding the value of advance directives. METHODS: We used data from survey proxies in the Health and Retirement Study involving adults 60 years of age or older who had died between 2000 and 2006 to determine the prevalence of the need for decision making and lost decision-making capacity and to test the association between preferences documented in advance directives and outcomes of surrogate decision making. RESULTS: Of 3746 subjects, 42.5% required decision making, of whom 70.3% lacked decision-making capacity and 67.6% of those subjects, in turn, had advance directives. Subjects who had living wills were more likely to want limited care (92.7%) or comfort care (96.2%) than all care possible (1.9%); 83.2% of subjects who requested limited care and 97.1% of subjects who requested comfort care received care consistent with their preferences. Among the 10 subjects who requested all care possible, only 5 received it; however, subjects who requested all care possible were far more likely to receive aggressive care as compared with those who did not request it (adjusted odds ratio, 22.62; 95% confidence interval [CI], 4.45 to 115.00). Subjects with living wills were less likely to receive all care possible (adjusted odds ratio, 0.33; 95% CI, 0.19 to 0.56) than were subjects without living wills. Subjects who had assigned a durable power of attorney for health care were less likely to die in a hospital (adjusted odds ratio, 0.72; 95% CI, 0.55 to 0.93) or receive all care possible (adjusted odds ratio, 0.54; 95% CI, 0.34 to 0.86) than were subjects who had not assigned a durable power of attorney for health care. CONCLUSIONS: Between 2000 and 2006, many elderly Americans needed decision making near the end of life at a time when most lacked the capacity to make decisions. Patients who had prepared advance directives received care that was strongly associated with their preferences. These findings support the continued use of advance directives.

Advance care planning · Confidence interval · Family medicine · Health care · Living Wills · Logistic regression · Odds · Odds ratio · Palliative care · Power of attorney · Test (biology) · Geriatric Care and Nursing Homes · Healthcare Decision-Making and Restraints · Internal Medicine · Medicine · Nursing · Palliative Care and End-of-Life Issues · Gerontology

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