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More than one-quarter of elderly patients lack decision-making capacity at death
Date:3/31/2010

are frequently confused with wills and durable powers or attorney which have no bearing on medical care decisions.

Of the subjects studied, 61 percent had advance directives. Of those, more than 90 percent requested either limited or comfort care at the end of life. Among those who needed decisions made, but couldn't make them themselves, 83% who had requested limited care and 97% who had requested comfort care, received the care that was in line with their wishes, Silveira says.

The study subjects were elderly Americans living at home or in facilities across the US who died between 2000 and 2006 and participated in the Health and Retirement Study, a national longitudinal study conducted at the University of Michigan's Institute for Social Research and funded by the National Institute on Aging.

"Folks with a living will or durable power of attorney for health care were less likely to die in a hospital or to get aggressive care -- but that is what most of them wanted," she says.

One interesting finding suggests the importance of having both a living will as well as an appointed surrogate decision-maker. The study showed that among the handful of subjects who indicated a preference for aggressive care, half did not receive it.

"Given this, some might conclude that advance directives are used to deny wanted health care, but our study showed that a preference for aggressive care had a very strong association with receiving such care, when compared to those who did not state a preference for it. It's just that at the end of life, aggressive treatment is often not an option; limited care and comfort care are always an option," Silveira says.

Co-authoring the study were Kenneth M. Langa, M.D., Ph.D., professor of in the Department of Internal Medicine at the University of Michigan , core investigator with VA Ann Arbor Healthcare System's Clinical Management Research, and professor of Health Management and Policy in U-M's Sc
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Contact: Mary Masson
mfmasson@umich.edu
734-764-2220
University of Michigan Health System
Source:Eurekalert

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