Premium
Advance Care Planning and the Quality of End‐of‐Life Care in Older Adults
Author(s) -
Bischoff Kara E.,
Sudore Rebecca,
Miao Yinghui,
Boscardin Walter John,
Smith Alexander K.
Publication year - 2013
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12105
Subject(s) - medicine , advance care planning , end of life care , confidence interval , observational study , intensive care unit , cohort study , emergency medicine , quality of life (healthcare) , palliative care , emergency department , cohort , relative risk , gerontology , family medicine , nursing
Objectives To determine whether advance care planning influences quality of end‐of‐life care. Design In this observational cohort study, Medicare data and survey data from the H ealth and R etirement S tudy ( HRS ) were combined to determine whether advance care planning was associated with quality metrics. Setting The nationally representative HRS . Participants Four thousand three hundred ninety‐nine decedent subjects (mean age 82.6 at death, 55% women). Measurements Advance care planning ( ACP ) was defined as having an advance directive ( AD ), durable power of attorney ( DPOA ) or having discussed preferences for end‐of‐life care with a next of kin. Outcomes included previously reported quality metrics observed during the last month of life (rates of hospital admission, in‐hospital death, >14 days in the hospital, intensive care unit admission, >1 emergency department visit, hospice admission, and length of hospice ≤3 days). Results Seventy‐six percent of subjects engaged in ACP . Ninety‐two percent of AD s stated a preference to prioritize comfort. After adjustment, subjects who engaged in ACP were less likely to die in a hospital (adjusted relative risk (a RR ) = 0.87, 95% confidence interval ( CI ) = 0.80–0.94), more likely to be enrolled in hospice (a RR = 1.68, 95% CI = 1.43–1.97), and less likely to receive hospice for 3 days or less before death (a RR = 0.88, 95% CI = 0.85–0.91). Having an AD , a DPOA or an ACP discussion were each independently associated with a significant increase in hospice use ( P < .01 for all). Conclusion ACP was associated with improved quality of care at the end of life, including less in‐hospital death and increased use of hospice. Having an AD , assigning a DPOA and conducting ACP discussions are all important elements of ACP .