Brief communication: the relationship between having a living will and dying in place.

TitleBrief communication: the relationship between having a living will and dying in place.
Publication TypeJournal Article
Year of Publication2004
AuthorsDegenholtz, HB, Rhee, YJ, Arnold, RM
JournalAnn Intern Med
Date Published2004 Jul 20
ISSN Number1539-3704
Call Numberpubs_2004_Degenholtz.pdf
KeywordsAged, Death, Health Status, Homes for the Aged, Hospices, Hospital Mortality, Housing, Humans, Living Wills, Nursing homes, Retrospective Studies

BACKGROUND: Living wills, a type of advance directive, are promoted as a way for patients to document preferences for life-sustaining treatments should they become incompetent. Previous research, however, has found that these documents do not guide decision making in the hospital.

OBJECTIVE: To test the hypothesis that people with living wills are less likely to die in a hospital than in their residence before death.

DESIGN: Secondary analysis of data from a nationally representative longitudinal study.

SETTING: Publicly available data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) study.

PATIENTS: People older than 70 years of age living in the community in 1993 who died between 1993 and 1995.

MEASUREMENTS: Self-report and proxy informant interviews conducted in 1993 and 1995.

RESULTS: Having a living will was associated with lower probability of dying in a hospital for nursing home residents and people living in the community. For people living in the community, the probability of in-hospital death decreased from 0.65 (95% CI, 0.58 to 0.71) to 0.52 (CI, 0.42 to 0.62). For people living in nursing homes, the probability of in-hospital death decreased from 0.35 (CI, 0.23 to 0.49) to 0.13 (CI, 0.07 to 0.22).

LIMITATIONS: Retrospective survey data do not contain detailed clinical information on whether the living will was consulted.

CONCLUSION: Living wills are associated with dying in place rather than in a hospital. This implies that previous research examining only people who died in a hospital suffers from selection bias. During advance care planning, physicians should discuss patients' preferences for location of death.

User Guide Notes

Endnote Keywords

Advance Directives/HOSPITALIZATION

Endnote ID


Alternate JournalAnn Intern Med
Citation Key6984
PubMed ID15262666
Grant List1R0 3AG18811-01 / AG / NIA NIH HHS / United States