Use of Advance Directives in Long-term Care Populations
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Adrienne L. Jones, Abigail J. Moss, and Lauren D. Harris-Kojetin, Ph.D.
Division of Health Care Statistics
Data from the 2004 National Nursing Home Survey and the 2007 National Home and Hospice Care Survey
* Overall, 28% of home health care patients, 65% of nursing home residents, and 88% of discharged hospice care patients had at least one advance directive (AD) on record.
* The most common types of ADs among home health care patients, nursing home residents, and discharged hospice care patients were living wills and do not resuscitate orders.
* Care recipients under age 65 years were less likely to have any AD than those aged 85 and over; black care recipients were less likely than white care recipients to have any AD in all three populations. These age and racial differences were larger in the home health care and nursing home populations than in the hospice care population.
An advance directive (AD) allows a patient to communicate health care preferences in the event that he or she is no longer able to make these decisions (1). Many view advance care planning (ACP)-a process that includes discussing values and goals of care among the patient, family, and physician, and determining or executing treatment directives-as a way to help ensure that wishes about end-of-life care are honored (2). Ideally, ADs are part of the ACP process. Twenty years ago, Congress passed the Patient Self-Determination Act (PSDA) requiring most health care facilities to inform adult patients about their rights to execute an AD (2). Research indicates that the preference for having an AD can be influenced by individual attitudes, cultural beliefs, health conditions, and trust in health care professionals (2-9). This report presents the latest national data on ADs in three long-term care populations-those receiving home health care or hospice care and those residing in nursing homes.
Keywords: patient self-determination act, advance care planning, aging, end of life
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