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Advance Directives Effectively Guide End-of-Life Care

Elderly people who have living wills in place tend to receive the kind of care they request

WEDNESDAY, March 31 (HealthDay News) -- Elderly persons with reduced decision-making capacity who have prepared advance directives, such as living wills, are likely to receive the kind of end-of-life care they request, according to research published in the April 1 issue of the New England Journal of Medicine.

Maria J. Silveira, M.D., of the Veterans Affairs Center for Clinical Management Research in Ann Arbor, Mich., and colleagues analyzed data from the Health and Retirement Study that surveyed 3,746 respondents age 60 and older to evaluate decision-making capacity in the group as well as their provisions for decision-making support.

The researchers found that 42.5 percent of the respondents needed decision-making support, with 70.3 percent of those as the result of reduced decision-making capacity. Among those lacking decision-making capacity, 67.6 percent had advance directives, such as living wills. In their living wills, respondents said they wanted comfort care (96.2 percent), limited care (92.7 percent), and all possible care (1.9 percent). Further, 83.2 percent of those requesting limited care and 97.1 percent of those requesting comfort care received the type of care they had requested. Among those requesting all possible care, just 50 percent received care consistent with their instructions; however, these patients were more likely to receive aggressive care than those who did not request all care possible.

"Between 2000 and 2006, many elderly Americans needed decision-making near the end of life at a time when most lacked the capacity to make decisions. Patients who had prepared advance directives received care that was strongly associated with their preferences. These findings support the continued use of advance directives," the authors write.

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