End-of-Life Care Planning

End-of-Life Care Planning: Research shows that the medical care elderly receive at the end-of-life is often different from what they would choose, and most elderly say they would prefer to die at home rather than in hospitals and nursing homes as most now do. More than one in four elderly Americans are incapacitated at the end of their lives and unable to make their own medical care decisions, according to the first large-scale study of advance directives based on the deaths of HRS participants. The researchers found that the overwhelming majority of older adults who died with advance directives received the care they preferred. Those with a living will or durable power of attorney for health care (two-thirds of the total) were less likely to die in a hospital or to receive aggressive care, results that were consistent with their wishes.

Planning for end-of-life care is more effective when it is seen as an ongoing process of decisionmaking among patient, family members, and health care providers, rather than the creation of a legal document. Verbal information provided over multiple educational sessions is most likely to lead to end-of-life plans. Timing is important; educational interventions that targeted seriously ill patients are most successful. But researchers find that one-size-fits-all approaches to end-of-life care planning may exclude large numbers of patients in an increasingly ethnically diverse society, and point out that the challenge is to "design, test, and implement programs which accommodate a range of individual and cultural beliefs, values, and preferences."