ADVANCE DIRECTIVES AMONG THE OLDEST OLD

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DESCRIPTION: Advance directives have been promoted as a way to recognize the importance of patients in making decisions about their own health care. By documenting preferences for the use of life sustaining medical treatments, proponents of advance directives hope that the values of dignity, personal autonomy and comfort will play a larger role in treatment decisions at the end of life. Most research on the completion and use of advance directives has focused on hospitalized patients or nursing home residents. Several studies have examined advance directives in outpatient samples. There have been few studies, however, of the presence or use of advance directives in population-based samples. The proposed study will address the following specific research questions: (1) What is the prevalence of advance directives among community-dwelling older people who died between 1994 and 1995? (2) What health and socio-demographic factors are associated with use of advance directives among community-dwelling older people who died between 1994 and 1995? (3) What is the relationship between the use of advance directives and the setting (i.e., home, hospital, nursing home, or hospice) where people die? And (4) What is the effect of the older person's advance directives on health expenses and experience of symptoms before death? The proposed study will use data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) Wave 2 Exit Survey. The AHEAD survey is a nationally representative longitudinal panel survey of people who were over 70 in 1993 (Wave 1). The Exit Survey was conducted with proxy informants for participants in Wave 1 who died before Wave 2. The proposed study will make an important contribution to our understanding of how advance directives shape end of life care. Previous studies have suggested that advance directives often do not have a major impact on the use of health care at the end of life. However, the majority of these studies examined people receiving health care in a hospital setting. It is unknown, therefore, whether people who have considered their preferences for end of life care and have written an advance directive or designated a health care power of attorney are likely to avoid going to a hospital or nursing home before death. Such a finding would suggest that most previous studies are subject to selection bias. By using data from a community-based sample, we will be able to address this significant limitation in the literature on advance directives. This study will produce preliminary findings that will provide the background for further research with these data.