%0 Journal Article %J Ann Intern Med %D 2004 %T Brief communication: the relationship between having a living will and dying in place. %A Howard B Degenholtz %A Rhee, YongJoo %A Robert M. Arnold %K Aged %K Death %K Health Status %K Homes for the Aged %K Hospices %K Hospital Mortality %K Housing %K Humans %K Living Wills %K Nursing homes %K Retrospective Studies %X

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.

%B Ann Intern Med %I 141 %V 141 %P 113-7 %8 2004 Jul 20 %G eng %N 2 %L pubs_2004_Degenholtz.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15262666?dopt=Abstract %4 Advance Directives/HOSPITALIZATION %$ 16020 %R 10.7326/0003-4819-141-2-200407200-00009