How advance directives may affect end-of-life care

Advance directives document patient preferences for future care, including end-of-life. An analysis in the Journal of the American Geriatrics Society has found that older patients with an advance directive that had been uploaded to the electronic health record at least six months before death were 25% less likely to experience potentially burdensome end-of-life care (19.9% versus 26.8%) and 31% less likely to have died in the hospital (23.2% versus 32.1%).

In the research, which was a secondary analysis of data on 2,850 US primary care patients aged ≥65 years who died during a randomized trial on the impact of advanced care planning, these associations remained significant after taking into account patients’ demographics, comorbidities, and health care use. However, the associations were attenuated among patients with dementia and Black patients, emphasizing the need for greater attention and additional research on this topic in these populations.

“Advance directives are often discussed as legal documents, but our findings suggest that when these documents are accessible in the electronic health record well before death, they may be associated with less burdensome care and fewer hospital deaths among older adults,” said corresponding author Danny L. Scerpella, MPH, of the Johns Hopkins Bloomberg School of Public Health.

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