Document Type

Article

Language

eng

Publication Date

3-2020

Publisher

Elsevier

Source Publication

Heart and Lung

Source ISSN

0147-9563

Abstract

Background

Older adults prefer comfort over life-sustaining care. Decreased intensity of care is associated with improved quality of life at the end-of-life (EOL).

Objectives

This study explored the association between advance directives (ADs) and intensity of care in the acute care setting at the EOL for older adults.

Methods

A retrospective, correlational study of older adult decedents (N = 496) was conducted at an academic medical center. Regression analyses explored the association between ADs and intensity of care.

Results

Advance directives were not independently predictive of aggressive care but were independently associated with referrals to palliative care and hospice; however, effect sizes were small, and the timing of referrals was late.

Conclusion

The ineffectiveness of ADs to reduce aggressive care or promote timely referrals to palliative and hospice services, emphasizes persistent inadequacies related to EOL care. Research is needed to understand if this failure is provider-driven or a flaw in the documents themselves.

Comments

Accepted version. Heart and Lung, Vol. 49, No. 2 (March/April 2020): 123-131. DOI. © 2020 Elsevier. Used with permission.

Available for download on Friday, April 30, 2021

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