Prevalence, views, and impact of advance directives among older adults

This article reviews the literature on advance directives among U.S. older adults published from 2008 through 2013, with a focus on advance directive prevalence, implications of advance directives on patient care, and impact of interventions to increase advance directive completion. Advance directive completion varies by demographic characteristics and is affected by patient attitudes toward advance directives and end-of-life care. Patients with advance directives are less likely to receive feeding tubes, experience burdensome transitions between nursing homes and hospitals, and die in the hospital. Advance directive completion increases when health care providers ask culturally sensitive questions and educate patients about advance directives, but better documentation and communication of advance directives are needed to ensure adherence to these measures. Despite increasing advance directive completion as patients move from community to nursing homes to hospice, advance directives are often insufficiently detailed and current for health care professionals to be confident they are acting in accordance with what patients would choose for themselves.