Advance Care Planning and the Quality of End-of-Life Care in Older Adults

TitleAdvance Care Planning and the Quality of End-of-Life Care in Older Adults
Publication TypeJournal Article
Year of Publication2013
AuthorsBischoff, KE, Sudore, RL, Miao, Y, Boscardin, WJ
JournalJournal of the American Geriatrics Society
Volume61
Issue2
Pagination209-214
KeywordsEnd of life decisions, Healthcare, Other, Retirement Planning and Satisfaction
Abstract

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. J Am Geriatr Soc 61:209-214, 2013.

Notes

Times Cited: 0

DOI10.1111/jgs.12105
Endnote Keywords

Advance care planning/End of life/quality of care/hospice/Advance directives/Durable power of attorney

Endnote ID

999999

Citation Key7821
PubMed ID23350921
PubMed Central IDPMC3760679