The prevalence of advance directives: lessons from a nursing home

This study of an elderly population examined the prevalence of advance directives, the barriers to documentation, and the relation of anxiety to advance directives. Elders (mean age 77.7 years) residing in a nursing home comprised the convenience sample (n = 104). Data were obtained by record review for the total sample, and personal interviews with 17 residents. Descriptive statistics and the chi 2-test of proportions were employed for analysis. The prevalence of documentation was 51.9% (n = 104), including 35 do-not-resuscitate orders, 17 health care powers of attorney, 16 medical directives, and 13 living wills; 18 records contained more than one directive. Those interviewed, both with and without advance directives, revealed low death anxiety (Templer's Death Anxiety Scale) reminiscing freely about their lives and experiences. Barriers suggested by the self-reports were misconceptions, little knowledge, opportunity, or interest in preparing directives, and the belief that clinicians or family were responsible for end-of-life decisions.