Assessing advance directives in the homebound elderly.

Area of Science:

• Gerontology
• Public Health
• Bioethics

Background:

• Advance directives are crucial for end-of-life care planning.
• Indigent, homebound older adults often face unique challenges in accessing healthcare services, including legal documentation.
• Understanding barriers to advance directive completion is essential for improving healthcare planning for vulnerable elderly populations.

Purpose of the Study:

• To identify barriers preventing indigent, homebound older adults from obtaining advance directives.
• To evaluate the effectiveness of clinical reminders in increasing advance directive completion among this demographic.

Main Methods:

• A study involving 1569 clients to assess advance directive status.
• Follow-up interviews with 530 clients lacking advance directives after 3 months.
• Qualitative assessment of reasons for non-completion among persistent non-completers.

Main Results:

• A significant proportion of identified barriers (57.8%) were linked to client reluctance to confront mortality.
• Clinical reminders implemented by case managers did not effectively reduce the number of homebound older adults without advance directives.
• The study highlights persistent challenges in encouraging advance directive completion in this population.

Conclusions:

• Reluctance to discuss mortality is a primary barrier for homebound elderly in completing advance directives.
• Current clinical reminder strategies are insufficient for this population.
• Further research is needed to develop targeted interventions to encourage advance directive completion among homebound older adults.