Advance Directives: The Key to a Good Death?

Abele, Patricia; Morley, John E.

doi:10.1016/j.jamda.2016.01.020

Cited by 24 publications

(7 citation statements)

References 48 publications

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“…One way to increase the probability that patients die in a place and manner of their choosing is for them to specify their choices by drawing up an Advance Care Directive. Since the Patient Determination Act in 1990 (Abele & Morley, 2016), U.S. patients have been able to choose whether to have medical treatment or not, to make advance care directives, and to transfer their decisionmaking power to a friend or relative. Since 2016, Medicare has paid physicians to discuss end-of-life issues in order to help patients draw up their directives.…”

Section: Long-term Care Insurancementioning

confidence: 99%

End-of-Life Medical Expenses

French¹,

Jones

Kelly

et al. 2018

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In this review, we document end-of-life medical spending: its level, composition, funding, and contribution to aggregate medical spending. We discuss how end-oflife expenses affect household behavior and economic evidence on the efficacy of medical spending at the end of life. Finally, we document recent trends in health and chronic disease at older ages and discuss what they might imply for end-of-life spending and medical spending in the aggregate. * Prepared for the 9 th Edition of the Handbook of Aging and the Social Sciences. Corresponding

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Section: Long-term Care Insurancementioning

confidence: 99%

End-of-Life Medical Expenses

French¹,

Jones

Kelly

et al. 2018

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“…10,11 ACP in nursing homes should address both resuscitation and hospitalization preference. 7 The overall hospitalization rate was 1.47 times higher for nursing home residents who had ACP without addressing…”

mentioning

confidence: 99%

Changes in Advance Care Planning for Nursing Home Residents During the COVID-19 Pandemic

Fry

Champion

2021

Journal of the American Medical Directors Association

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Objective: Describe the care preference changes among nursing home residents receiving proactive Advance Care Planning (ACP) conversations from health care practitioners during the COVID-19 pandemic. Design: Retrospective chart review. Setting and Participants: Nursing home residents (n ¼ 963) or their surrogate decision makers had at least 1 ACP conversation with a primary health care practitioner between April 1, 2020, and May 30, 2020, and made decisions of any changes in code status and hospitalization preferences. Methods: Health care practitioners conducted ACP conversations proactively with residents or their surrogate decision makers at 15 nursing homes in a metropolitan area of the southwestern United States between April 1, 2020, and May 30, 2020. ACP conversations reviewed code status and goals of care including Do Not Hospitalize (DNH) care preference. Resident age, gender, code status, and DNH choice before and after the ACP conversations were documented. Descriptive data analyses identified significant changes in resident care preferences before and after ACP conversations. Results: Before the most recent ACP discussion, 361 residents were full code status and the rest were Out of Hospital Do Not Resuscitate (DNR). Of the individuals with Out of Hospital DNR, 188 residents also chose DNH. After the ACP conversation, 88 residents opted to change from full code status to Out of Hospital DNR, thereby increasing the percentage of residents with Out of Hospital DNR from 63% to 72%. Almost half of the residents decided to keep or change to the DNH care option after the ACP conversation. Conclusion and Implications: Proactive ACP conversations during COVID-19 increased DNH from less than a quarter to almost half among the nursing home residents. Out of Hospital DNR increased by 9%. It is important for all health care practitioners to proactively review ACP with nursing home residents and their surrogate decision makers during a pandemic, thereby ensuring care consistent with personal goals of care and avoiding unnecessary hospitalizations.

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“…Importantly, however, the relational significance of our data point to a requirement to focus on the collective and interdependent nature of the ‘emergent’ process. In the United States of America, recently the relational imperative has led to funding for joint physician and patient conversations about ACP (Abele and Morley, 2016). Furthermore, the importance of trusting relationships with professionals can yield a supportive experience for families in their attempts to come to terms with decisions about future medical treatments.…”

Section: Discussionmentioning

confidence: 99%

Couples affected by dementia and their experiences of advance care planning: a grounded theory study

Ryan

McKeown

2018

Ageing and Society

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Global policy places emphasis on the implementation and usage of advance care planning (ACP) to inform decision making at the end of life. For people with dementia, where its use is encouraged at the point of diagnosis, utilisation of ACP is relatively poor, particularly in parts of Europe. Using a constructivist grounded theory methodology, this study explores the ways in which co-residing couples considered ACP. Specifically, it seeks to understand the ways in which people with dementia and their long-term co-residing partners consider and plan, or do not plan, for future medical and social care. Sixteen participants were interviewed. They identified the importance of relationships in the process of planning alongside an absence of formal service support and as a result few engaged in ACP. The study recognises the fundamental challenges for couples in being obliged to consider end-of-life issues whilst making efforts to ‘live well’. Importantly, the paper identifies features of the ACP experience of a relational and biographical nature. The paper challenges the relevance of current global policy and practice, concluding that what is evident is a process of ‘emergent planning’ through which couples build upon their knowledge of dementia, their networks and relationships, and a number of ‘tipping points’ leading them to ACP. The relational and collective nature of future planning is also emphasised.

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Advance Directives: The Key to a Good Death?

Cited by 24 publications

References 48 publications

End-of-Life Medical Expenses

End-of-Life Medical Expenses

Changes in Advance Care Planning for Nursing Home Residents During the COVID-19 Pandemic

Couples affected by dementia and their experiences of advance care planning: a grounded theory study

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