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Elderly Lack Decision-Making Capacity at Death
More than one in four elderly Americans lacked the capacity to make their own medical care decisions at the end of life, according to a study of 3,746 people.
Those who had advance directives - including living wills or durable powers of attorney for healthcare - received the care they wanted most of the time, says lead author Maria Silveira, assistant professor of Internal Medicine at the University of Michigan.
"Prior to our study, no one knew how many elderly adults might need others to make complex medical decisions on their behalf at the end of life," says Silveira. "Our research shows that a substantial number of older adults need someone else to make decisions about whether aggressive, limited, or comfort care should be provided at the end of life."
According to Silveira, the study underscores the need to prepare oneself and one's family for the often emotional and difficult medical decisions that can arise at the end of life. It also suggests that the time spent to craft a living will and appoint a durable power of attorney for health care can be worthwhile.
Advance directives usually document patients' wishes for life-sustaining treatment in a living will, as well as their choice of a proxy decision-maker in a durable power of attorney for health care. Still, "There is a lot of myth and misunderstanding about advance directives," Silveira says.
For example, many people do not understand that advance directives are used only when patients can't make medical care decisions for themselves, and they can be revoked by the patient at any time, either in writing or orally. Advance directives are frequently confused with wills and durable powers or attorney – which have no bearing on medical care decisions.
Of the subjects studied, 61 percent had advance directives. Of those, more than 90 percent requested either limited or comfort care at the end of life. Among those who needed decisions made, but couldn't make them themselves, 83% who had requested limited care and 97% who had requested comfort care, received the care that was in line with their wishes, Silveira says.
The study subjects were elderly Americans living at home or in facilities across the US who died between 2000 and 2006 and participated in the Health and Retirement Study, a national longitudinal study conducted at the University of Michigan's Institute for Social Research and funded by the National Institute on Aging.
"Folks with a living will or durable power of attorney for health care were less likely to die in a hospital or to get aggressive care – but that is what most of them wanted," she says.
REHACARE.de; Source: University of Michigan Health System
- More about the University of Michigan Health System at www.med.umich.edu
( Source: REHACARE.de )