Advance Directive Status in the Greater Than 65-Year-Old Emergency Department Population
Author: Kelsey Grace , Michelle Carson MD, August Grace, David Betten MD
Author Affiliations: Sparrow Hospital Department of Emergency Medicine
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2018/02/ADirectiveEpub.pdf” type=”big” color=”green” newwindow=”yes”] Full Text Article PDF[/button]
Corresponding Author: Kelsey Grace, gracekel@msu.edu
Abstract:
Advance directives are an important aspect of medical care for the elderly given the uncertainty of health and longevity. In their absence, family and physicians are often left with questions regarding what patient’s wishes would entail if they become incapacitated. Individuals >65 years presenting to the ED were surveyed during the months of June-September 2015 by study investigators regarding their knowledge and utilization of advance directives. 168 patient surveys were completed with a mean age of 77.2 (SD ±7.45 years; range 65-97). Of those, 91% were either ―very familiar‖ or ―somewhat familiar‖ with Advance Directives with 76.1% having some form of documented advance directives in place. Of those who felt family were aware of their wishes, 84.9% had assigned a Medical Durable Power of Attorney. Only a small minority had developed advance directives with their physician’s assistance (6.8%). The majority of patients stated that they had prepared their end of life documents with a Lawyer (72%). Only 35.8% of patients sampled had even mentioned the topic or their specific wishes with their primary care or ED physician. Overall rates of formalized advance directives would appear to be highly utilized in this patient population with little variation based upon respondents’ self-assessment of physical health. A surprising finding was how minor of a role physicians appear to play in the development of ADs. This provides an opportunity to enhance the physician-patient relationship and improve patient education regarding end of care discussions. Physicians should take initiative and begin having these conversations, in order to ensure that patients are making educated decisions and that proper documentation is occurring.
Published on date: February, 2018
DOI: 10.15404/msrj/02.2018.0152
Citation: Grace, K., Carson, M., Grace, A. et al. Advance Directive Status in the Greater Than 65-Year-Old Emergency Department Population, Medical Student Research Journal (2018). doi:10.15404/msrj/02.2018.0152
References:
1. Koch, K. Patient Self-Determination Act. J Fla Med Assoc. 1992. 79:240–243.
2. O’Sullivan, R., Malio, K., Angeles, R., Agarwal, G. Advance directives: survey of primary care patients. Can Fam Physicians. 2015. 61(4):353-356.
3. Oulton, J., Rhodes, S., Howe, C., et al. Advanced directives for older adults in the emergency department: a systematic review. J Pallait Med. 2015. 18(6):500-505.
4. Llovera, I., Ward, M., Ryan, J., et al. Why don’t emergency department patients have Advanced directives? Academic Emergency Medicine. 1999. 6(10):1054-1060.
5. Ishihara KK, Wrenn K, Wright SW, Socha CM, Cross M. Advance directives in the emergency department: too few, too late. Acad Emerg Med. 1996. 3:50–53.
6. Emanuel LL, Barry MJ, Stoeckle JD, Ettelson LM, Emanuel EJ. Advance directives for medical care—a case for greater use. New Engl J Med. 1991;324(13):889–895.
7. Spoelhof GD, Elliott B. Implementing Advance directives in office practice. Am Fam Physician. 2012. 85(5):461–466.
8. Edinger W, Smucker DR. Outpatients’ attitudes regarding Advance directives. J Fam Pract. 1992. 35(6):650–653.
9. Tierney WM, Dexter PR, Gramelspacher GP, Perkins AJ, Zhou XH, Wolinsky FD. The effect of discussions about Advance directives on patients’ satisfaction with primary care. J Gen Intern Med. 2001;16(1):32–40. (Patient satisfaction with physicians increases if directives are discussed).
