Advance Care Planning and the Quality of End-of-Life Care in Older Adults

• Autores: Kara E. Bischoff, Rebecca L. Sudore, Yinghui Miao, W. John Boscardin, Alexander K. Smith
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 61, Nº. 2, 2013, págs. 209-214
• Idioma: inglés
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• Dialnet Métricas: 4 Citas
• Resumen

  • Objectives: To determine whether advance care planning influences quality of end-of-life care.

    Design: In this observational cohort study, Medicare data and survey data from the Health and Retirement Study (HRS) were combined to determine whether advance care planning was associated with quality metrics.

    Setting: The nationally representative HRS.

    Participants: Four thousand three hundred ninety-nine decedent subjects (mean age 82.6 at death, 55% women).

    Measurements: Advance care planning (ACP) was defined as having an advance directive (AD), durable power of attorney (DPOA) or having discussed preferences for end-of-life care with a next of kin. Outcomes included previously reported quality metrics observed during the last month of life (rates of hospital admission, in-hospital death, >14 days in the hospital, intensive care unit admission, >1 emergency department visit, hospice admission, and length of hospice ?3 days).

    Results: Seventy-six percent of subjects engaged in ACP. Ninety-two percent of ADs stated a preference to prioritize comfort. After adjustment, subjects who engaged in ACP were less likely to die in a hospital (adjusted relative risk (aRR) = 0.87, 95% confidence interval (CI) = 0.80�0.94), more likely to be enrolled in hospice (aRR = 1.68, 95% CI = 1.43�1.97), and less likely to receive hospice for 3 days or less before death (aRR = 0.88, 95% CI = 0.85�0.91). Having an AD, a DPOA or an ACP discussion were each independently associated with a significant increase in hospice use (P < .01 for all).

    Conclusion: ACP was associated with improved quality of care at the end of life, including less in-hospital death and increased use of hospice. Having an AD, assigning a DPOA and conducting ACP discussions are all important elements of ACP.