Advance directives and intensity of care delivered to hospitalized older adults at the end-of-life

Marsha H. Tyacke; Jill L. Guttormson; Mauricio Garnier-Villarreal; Kathryn Schroeter; Wendy Peltier

doi:10.1016/j.hrtlng.2019.08.018

Advance directives and intensity of care delivered to hospitalized older adults at the end-of-life

Marsha H. Tyacke, Jill L. Guttormson^*, Mauricio Garnier-Villarreal, Kathryn Schroeter, Wendy Peltier

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Background: Older adults prefer comfort over life-sustaining care. Decreased intensity of care is associated with improved quality of life at the end-of-life (EOL). Objectives: This study explored the association between advance directives (ADs) and intensity of care in the acute care setting at the EOL for older adults. Methods: A retrospective, correlational study of older adult decedents (N = 496) was conducted at an academic medical center. Regression analyses explored the association between ADs and intensity of care. Results: Advance directives were not independently predictive of aggressive care but were independently associated with referrals to palliative care and hospice; however, effect sizes were small, and the timing of referrals was late. Conclusion: The ineffectiveness of ADs to reduce aggressive care or promote timely referrals to palliative and hospice services, emphasizes persistent inadequacies related to EOL care. Research is needed to understand if this failure is provider-driven or a flaw in the documents themselves.

Original language	English
Pages (from-to)	123-131
Number of pages	9
Journal	Heart and Lung
Volume	49
Issue number	2
DOIs	https://doi.org/10.1016/j.hrtlng.2019.08.018
Publication status	Published - 1 Mar 2020
Externally published	Yes

Funding

This project was supported, in part, by the National Center for Research Resources and the National Center for Advancing Translational Sciences , National Institutes of Health , through grant number UL1TR001436 . Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Funders	Funder number
National Institutes of Health
National Center for Research Resources
National Center for Advancing Translational Sciences	UL1TR001436

Keywords

acute care
advance directives
end-of-life
quality of life

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10.1016/j.hrtlng.2019.08.018

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title = "Advance directives and intensity of care delivered to hospitalized older adults at the end-of-life",

abstract = "Background: Older adults prefer comfort over life-sustaining care. Decreased intensity of care is associated with improved quality of life at the end-of-life (EOL). Objectives: This study explored the association between advance directives (ADs) and intensity of care in the acute care setting at the EOL for older adults. Methods: A retrospective, correlational study of older adult decedents (N = 496) was conducted at an academic medical center. Regression analyses explored the association between ADs and intensity of care. Results: Advance directives were not independently predictive of aggressive care but were independently associated with referrals to palliative care and hospice; however, effect sizes were small, and the timing of referrals was late. Conclusion: The ineffectiveness of ADs to reduce aggressive care or promote timely referrals to palliative and hospice services, emphasizes persistent inadequacies related to EOL care. Research is needed to understand if this failure is provider-driven or a flaw in the documents themselves.",

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author = "Tyacke, {Marsha H.} and Guttormson, {Jill L.} and Mauricio Garnier-Villarreal and Kathryn Schroeter and Wendy Peltier",

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doi = "10.1016/j.hrtlng.2019.08.018",

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AU - Tyacke, Marsha H.

AU - Guttormson, Jill L.

AU - Garnier-Villarreal, Mauricio

AU - Schroeter, Kathryn

AU - Peltier, Wendy

PY - 2020/3/1

Y1 - 2020/3/1

N2 - Background: Older adults prefer comfort over life-sustaining care. Decreased intensity of care is associated with improved quality of life at the end-of-life (EOL). Objectives: This study explored the association between advance directives (ADs) and intensity of care in the acute care setting at the EOL for older adults. Methods: A retrospective, correlational study of older adult decedents (N = 496) was conducted at an academic medical center. Regression analyses explored the association between ADs and intensity of care. Results: Advance directives were not independently predictive of aggressive care but were independently associated with referrals to palliative care and hospice; however, effect sizes were small, and the timing of referrals was late. Conclusion: The ineffectiveness of ADs to reduce aggressive care or promote timely referrals to palliative and hospice services, emphasizes persistent inadequacies related to EOL care. Research is needed to understand if this failure is provider-driven or a flaw in the documents themselves.

AB - Background: Older adults prefer comfort over life-sustaining care. Decreased intensity of care is associated with improved quality of life at the end-of-life (EOL). Objectives: This study explored the association between advance directives (ADs) and intensity of care in the acute care setting at the EOL for older adults. Methods: A retrospective, correlational study of older adult decedents (N = 496) was conducted at an academic medical center. Regression analyses explored the association between ADs and intensity of care. Results: Advance directives were not independently predictive of aggressive care but were independently associated with referrals to palliative care and hospice; however, effect sizes were small, and the timing of referrals was late. Conclusion: The ineffectiveness of ADs to reduce aggressive care or promote timely referrals to palliative and hospice services, emphasizes persistent inadequacies related to EOL care. Research is needed to understand if this failure is provider-driven or a flaw in the documents themselves.

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Advance directives and intensity of care delivered to hospitalized older adults at the end-of-life

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