Clinical Briefs

Use of Advance Directives by Community-Dwelling Older Adults

Since 1990, subsequent to the Self-Determination Act, health care facilities participating in Medicaid or Medicare must inform patients in writing about their rights in reference to advance directives (i.e., wishes of the patient about their medical care when they are seriously ill or near death and may not be able to directly communicate their express interests). This Act is focused specifically on inpatient populations, but sentiment for expanding to the ambulatory setting is growing. This study looked at free-living noninstitutionalized older adults to assess the level of planning for future care.

Study subjects (n = 571) completed a telephone interview during which they were essentially asked three questions based upon the type of medical care they would want (or not want) in the event they were ill and unable to make decisions for themselves: 1) Have you talked to someone about this issue?; 2) Have you talked to your doctor about this issue?; 3) Have you made written plans for this possibility?

Almost half of respondents had participated in discussion of this issue with someone, but only 13.5% had used a physician in this regard, and only 16.1% had written plans.

The failure of the physician to initiate discussion about advance directives is commonly noted as a primary stumbling block in its accomplishment. Physicians who find merit in advance directives for their patients have great opportunity for enhancing this channel of interaction.

Kvale JN, et al. J Clin Outcomes Man 1999;6(1)39-43.