Navigation Links
Advance Directives Help Assure End-of-Life Wishes Are Honored
Date:3/31/2010

Nearly one-third of those dying needed someone else to make decisions, research finds

WEDNESDAY, March 31 (HealthDay News) -- When people prepare advance directives, such as a living will or a durable power of attorney for health care, most will receive the type of medical care that they've requested as they near the end of their lives, a new study suggests.

The study also found that 30 percent of people required another person to make decisions for them at the end of life. This highlights the need to prepare some kind of advance directive and to discuss end-of-life care wishes with your loved ones before you get sick, the study authors said.

"We conducted an observational study of elderly across the United States, and probably the single most interesting finding was that 29.8 percent needed some form of medical decision-making on their behalf before they died," said the study's lead author, Dr. Maria J. Silveira, a clinician/scientist at the Veterans Affairs Center for Clinical Management Research and an assistant professor of internal medicine at the University of Michigan.

In the group that needed someone to make decisions for them, nearly 70 percent had completed an advance directive, according to results of the study, published in the April 1 issue of the New England Journal of Medicine.

Another study in the same issue of the journal also underscored the need for advance planning for end-of-life care. It found that during the last year of life, fewer than one in five people has no disability that interferes with daily living activities. Over the 10-year study period, nearly 50 percent of the study's older adult participants, who had been healthy and had no disabilities at the start of the study, had a progressive or persistently severe disability. The researchers said these disabilities didn't follow a common pattern and would be difficult to predict ahead of time.

Advance directives are documents that list your end-of-life care wishes (a living will) or who you would like to make those decisions for you if you are incapacitated (durable power of attorney for health care).

Silveira said that whenever someone enters a hospital or care facility, he or she is given the opportunity to complete an advance directive, which is one reason why so many elderly people may have these documents.

The problem, however, is that many people will designate a health-care proxy or prepare a living will and then tuck the document away without discussing it.

"People need to have conversations with the person they've appointed, not just put the document in a locked safe deposit box," said the author of an accompanying editorial in the same issue of the journal, Dr. Muriel R. Gillick, a clinical professor in the department of population medicine at Harvard Pilgrim Health Care Institute and Harvard Medical School in Boston.

Silveira's study included 3,746 people over 60 years old who died between 2000 and 2006. The vast majority of people with living wills -- 92.7 percent -- wanted only limited care at the end of their lives. Slightly more than 96 percent said they'd prefer comfort care. Only 1.9 percent requested all care possible.

The researchers found that 83.2 percent of those who requested limited care and 97.1 percent who asked for comfort care received the care they requested.

"People should be reassured [that] if they complete advance directives, they get what they want most of the time," Silveira said.

Gillick said she recommends designating a health-care proxy to make decisions for you, and to have a non-legal letter expressing your more specific wishes for medical care. She said the problem with many living wills is that they're too generic.

In her editorial, Gillick said, "The ongoing challenge is to transform advance care planning from the act of signing a form to a process that begins by clarifying the patient's current health status, moves to elicitation of the goals of care, and then designates a proxy to work with clinicians and interpreting and implementing these goals."

She suggests a better way to begin these discussions might be to show people short videos of potential medical scenarios so they have a better understanding of the procedures.

More information

Learn more about advance planning for end-of-life care at AARP.



SOURCES: Maria J. Silveira, M.D., M.P.H., clinician/scientist, Veterans Affairs Center for Clinical Management Research, and assistant professor of internal medicine, University of Michigan, Ann Arbor; Muriel Gillick, M.D., clinical professor, department of population medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston; April 1, 2010, New England Journal of Medicine


'/>"/>
Copyright©2010 ScoutNews,LLC.
All rights reserved

Related medicine news :

1. Lumension Partners With Citrix To Advance Desktop Virtualization Security
2. Advance Introduces the Adgility™ XPB Battery Backpack Vacuum – the Lightest in the Industry
3. BOTOX Cosmetic & Wrinkle Filler Specialist Hosts Advanced Training Event at Ageless Beauty in Mountain Home, ID
4. National Institutes of Health Awards Kitware Over $600,000 to Develop Advancements in Neurosurgical Simulation
5. South Carolina Senate Banking & Insurance Committee Advances Medigap Bill to Full Senate by Overwhelming Vote
6. AdvancedMD Appoints William Stone Vice President and General Manager of Billing Services Partner Program
7. MRC scientists announce advance in understanding bodys natural defenses
8. Fifty years of the light fantastic: Laser advances spark scientific progress
9. Prion Disease in Mice May Help Advance Alzheimers Research
10. Michael J. Fox Foundation awards Mayo Clinic researcher grant to advance Parkinson’s research
11. Greenway Medical Technologies Advances Patient-Provider Benefits
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/13/2016)... ... February 13, 2016 , ... DDi , a Makro ... list for its expertise in eClinical Solutions. DDi has built its solution competency ... needs of global clients. DDi provides smarter technology for Clinical Development, Regulatory and ...
(Date:2/12/2016)... ... February 12, 2016 , ... ... a new initiative—the Siemens Foundation-PATH Ingenuity Fellowships—to develop the advanced skills needed ... top students from U.S. universities who will draw from Siemens’ deep knowledge ...
(Date:2/12/2016)... ... , ... Each year, the American Physical Therapy Association (APTA) offers a Combined ... Convention Center. Almost 10,000 physical therapists across the country are expected to attend this ... their chosen field and network with their colleagues. As in years past, HydroWorx ...
(Date:2/12/2016)... ... February 12, 2016 , ... The ThedaCare ... San Francisco General Hospital on April 5-7. The series is a multi-day, multi-workshop ... habits. The workshops cover a broad range of topics, including coaching skills, the ...
(Date:2/12/2016)... ... February 12, 2016 , ... AssureVest Insurance Group, a locally owned ... charity drive that will raise funds earmarked to purchase computers and software for Mrs. ... , “My school is in a low-income area and has more than 60 2nd ...
Breaking Medicine News(10 mins):
(Date:2/11/2016)... , Feb. 11, 2016 The primary ... and future adoption patterns on the usage of liquid ... the following: - Timeframe of liquid biopsy ... ctDNA, cfDNA and Evs—by organization type - Sample inflow ... types: blood, saliva, stool, serum, and so on. - ...
(Date:2/11/2016)... 11, 2016  Walgreens has committed to provide drug ... Washington, D.C. as part of a ... commended by shareholder advocacy organization As You Sow. ... "Many people hold on to unneeded drugs because they lack ... consequences." --> Conrad MacKerron , Senior Vice ...
(Date:2/11/2016)... Feb. 11, 2016  MiMedx Group, Inc. (NASDAQ: ... amniotic membrane and other birth tissues, human skin and ... and market advanced products and therapies, announced today that ... Global Healthcare Conference in New York ... Michael J. Senken , Chief Financial Officer and ...
Breaking Medicine Technology: