|Title||Advance care planning and the quality of end-of-life care in older adults.|
|Publication Type||Journal Article|
|Year of Publication||2013|
|Authors||Bischoff, KE, Sudore, RL, Miao, Y, W Boscardin, J, Smith, AK|
|Journal||J Am Geriatr Soc|
|Date Published||2013 Feb|
|Keywords||Adaptation, Psychological, Advance care planning, Aged, 80 and over, Female, Humans, Male, Quality of Life, Terminal Care, United States|
OBJECTIVES: To determine whether advance care planning influences quality of end-of-life care.
DESIGN: In this observational cohort study, Medicare data and survey data from the Health and Retirement Study (HRS) were combined to determine whether advance care planning was associated with quality metrics.
SETTING: The nationally representative HRS.
PARTICIPANTS: Four thousand three hundred ninety-nine decedent subjects (mean age 82.6 at death, 55% women).
MEASUREMENTS: Advance care planning (ACP) was defined as having an advance directive (AD), durable power of attorney (DPOA) or having discussed preferences for end-of-life care with a next of kin. Outcomes included previously reported quality metrics observed during the last month of life (rates of hospital admission, in-hospital death, >14 days in the hospital, intensive care unit admission, >1 emergency department visit, hospice admission, and length of hospice ≤ 3 days).
RESULTS: Seventy-six percent of subjects engaged in ACP. Ninety-two percent of ADs stated a preference to prioritize comfort. After adjustment, subjects who engaged in ACP were less likely to die in a hospital (adjusted relative risk (aRR) = 0.87, 95% confidence interval (CI) = 0.80-0.94), more likely to be enrolled in hospice (aRR = 1.68, 95% CI = 1.43-1.97), and less likely to receive hospice for 3 days or less before death (aRR = 0.88, 95% CI = 0.85-0.91). Having an AD, a DPOA or an ACP discussion were each independently associated with a significant increase in hospice use (P < .01 for all).
CONCLUSION: ACP was associated with improved quality of care at the end of life, including less in-hospital death and increased use of hospice. Having an AD, assigning a DPOA and conducting ACP discussions are all important elements of ACP.
Times Cited: 0
|User Guide Notes|
|Endnote Keywords|| |
Advance care planning/End of life/quality of care/hospice/Advance directives/Durable power of attorney
|Endnote ID|| |
|Alternate Journal||J Am Geriatr Soc|
|PubMed Central ID||PMC3760679|
|Grant List||K23 AG040772 / AG / NIA NIH HHS / United States |
KL2 RR024130 / RR / NCRR NIH HHS / United States