Record number of older adults completing living wills

April 2, 2014

A record number of elderly people are completing living wills to guide end-of-life medical treatments – up from 47 percent in 2000 to 72 percent in 2010 – according to new research from the University of Michigan and the Veterans Affairs Ann Arbor Healthcare System.

However, even with nearly double the number of people completing advance directives – which may specify preferences for and life-support treatment – there was little difference in hospitalization rates or deaths in the hospital, says the study that appears in the Journal of the American Geriatrics Society.

"Given the aging population, there's been a great push to encourage more people to complete with the idea that this may increase hospice care and reduce hospitalization for patients during the last six months of life," says lead author and palliative care specialist Maria Silveira, M.D., M.A., M.P.H, researcher with the VA Ann Arbor Healthcare System and assistant professor in the Department of Internal Medicine at the U-M Medical School.

"We found that while there's an upward trend in creating these documents, it didn't have much bearing at all on hospitalization rates over the decade. Indeed, increased during the decade, rather than go down. These are really devices that ensure people's preferences get respected, not devices that can control whether a person chooses to be hospitalized before death."

Silveira says the increase in advanced directives indicates that people are less timid about broaching end-of-life planning and talking about death with loved ones.

"People seem more comfortable having 'the talk' about those dire "what-if" scenarios and death in general," says Silveira, who is also a member of the Institute for Healthcare Policy and Innovation. "It's become part of the routine check list in getting affairs in order, especially for older adults. People want to ease the burden upon their loved ones who will undoubtedly face difficult decisions when it comes to handling finances, medical treatment and other matters."

The study was based on data from the Health and Retirement Study, a nationally-representative sample of older Americans that is conducted by the U-M Institute for Social Research on behalf of the National Institute of Aging.

Recent headlines have shone a light on end-of-life treatment choices around the country. Among the most highly publicized cases was that of a brain-dead pregnant woman in Texas who was kept on life support because of confusion over state law. A judge ultimately ordered the Texas hospital to take the woman off of her ventilator in January to honor her family's wishes.

The recent study found that most people both appointed a surrogate and left their treatment preferences known. Among those who only had completed one document, more chose to appoint a surrogate than leave their treatment preferences in writing.

"Identifying the person you trust to make these types of medical decisions isn't as emotional a decision as deciding whether you'd want aggressive treatment or if you're dying," Silveira says. "It's much more difficult to make decisions about treatment because it often depends on unforeseeable factors such as how sick the person is, whether his or her brain is working and chances of recovery."

Silveira says that some insurers and stakeholders have encouraged primary care physicians to talk to healthy patients about whether they have completed a will, but the new findings suggest that the documents likely don't change the likelihood of hospitalization at the end of life or increase the likelihood the person will die at home.

Some people may also opt against a living will for cultural reasons, Silveira noted. For patients who believe families should make these decisions as a group, on their behalf, an advance directive may not be the correct way to prepare for the end of life, she says.

"As a physician, when you help a patient prepare for the end of life, it depends on the patient's age, their medical conditions, and their lifestyle," Silveira says. "As a family, it can never be too early to talk about these issues."

Explore further: Supply of hospice services strongly associated with local area's median household income

More information: "Advance Directive Completion by Elderly Americans: A Decade of Change," Journal of the American Geriatrics Society, 2014.

Related Stories

Supply of hospice services strongly associated with local area's median household income

May 9, 2011
Wealth, population size, race and age associate with the supply of hospice care available in a county, according to a study published in the Journal of Pain and Symptom Management this month.

NIH launches online resource for end-of-life issues

March 26, 2014
(HealthDay)—People grappling with terminal illness now have a new online source of advice and help, sponsored by the U.S. National Institute on Aging, part of the National Institutes of Health.

Half of hospitalized adults over 65 need surrogate decision-makers, study finds

January 22, 2014
Nearly half of hospitalized American adults age 65 and older require decision-making assistance from family members or other surrogates because the patient is too impaired to make decisions independently, according to a new ...

Advance directives related to use of palliative care, lower Medicare end-of-life spending

October 4, 2011
Advance directives do have an impact on health care at the end of life, especially in regions of the country with high spending on end-of-life care, according to a University of Michigan study.

Study: Making medical decisions for a cognitively impaired family member is complicated

August 15, 2013
Decision-making by a surrogate for a family member who is unable to make medical decisions is more complicated than decision-making by patients themselves, according to a study from the Regenstrief Institute, Indiana University ...

Recommended for you

To combat teen smoking, health experts recommend R ratings for movies that depict tobacco use

July 21, 2017
Public health experts have an unusual suggestion for reducing teen smoking: Give just about any movie that depicts tobacco use an automatic R rating.

Aging Americans enjoy longer life, better health when avoiding three risky behaviors

July 20, 2017
We've heard it before from our doctors and other health experts: Keep your weight down, don't smoke and cut back on the alcohol if you want to live longer.

Opioids and obesity, not 'despair deaths,' raising mortality rates for white Americans

July 20, 2017
Drug-related deaths among middle-aged white men increased more than 25-fold between 1980 and 2014, with the bulk of that spike occurring since the mid-1990s when addictive prescription opioids became broadly available, according ...

Parents have critical role in preventing teen drinking

July 20, 2017
Fewer teenagers are drinking alcohol but more needs to be done to curb the drinking habits of Australian school students, based on the findings of the latest study by Adelaide researchers.

Fresh fish oil lowers diabetes risk in rat offspring

July 19, 2017
Fresh fish oil given to overweight pregnant rats prevented their offspring from developing a major diabetes risk factor, Auckland researchers have found.

High-dose vitamin D doesn't appear to reduce the winter sniffles for children

July 18, 2017
Giving children high doses of vitamin D doesn't appear to reduce the winter sniffles, a new study has found.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.