Advance directives and outcomes of surrogate decision making before death.

TitleAdvance directives and outcomes of surrogate decision making before death.
Publication TypeJournal Article
Year of Publication2010
AuthorsSilveira, MJ, Kim, SYH, Langa, KM
JournalN Engl J Med
Volume362
Issue13
Pagination1211-8
Date Published2010 Apr 01
ISSN Number1533-4406
KeywordsAdvance directives, Aged, Aged, 80 and over, Decision making, Female, Humans, Living Wills, Logistic Models, Male, Mental Competency, Middle Aged, Proxy, Terminal Care, United States
Abstract

<p><b>BACKGROUND: </b>Recent discussions about health care reform have raised questions regarding the value of advance directives.</p><p><b>METHODS: </b>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.</p><p><b>RESULTS: </b>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.</p><p><b>CONCLUSIONS: </b>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.</p>

URLhttp://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2000244791andFmt=7andclientId=17822andRQT=309andVName=PQD
DOI10.1056/NEJMsa0907901
User Guide Notes

http://www.ncbi.nlm.nih.gov/pubmed/20357283?dopt=Abstract

Endnote Keywords

Right to die/Powers of attorney/Decision making/Health care/Advance directives

Endnote ID

22570

Alternate JournalN. Engl. J. Med.
Citation Key7459
PubMed ID20357283
PubMed Central IDPMC2880881
Grant ListR01 AG027010-01 / AG / NIA NIH HHS / United States
U01 AG009740 / AG / NIA NIH HHS / United States
U01 AG09740 / AG / NIA NIH HHS / United States
R01 AG027010 / AG / NIA NIH HHS / United States
U01 AG009740-10 / AG / NIA NIH HHS / United States