|Title||Brief communication: the relationship between having a living will and dying in place.|
|Publication Type||Journal Article|
|Year of Publication||2004|
|Authors||Degenholtz, HB, Rhee, YJ, Arnold, RM|
|Journal||Ann Intern Med|
|Date Published||2004 Jul 20|
|Keywords||Aged, 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|| |
|Endnote ID|| |
|Alternate Journal||Ann Intern Med|
|Grant List||1R0 3AG18811-01 / AG / NIA NIH HHS / United States|