Prevalence of advance directives among elderly patients attending an urban Canadian emergency department

Abstract

Introduction: To date, there has been minimal research on advance directives (ADs) among elderly patients in Canadian emergency departments (EDs). The purpose of this study was to determine the prevalence of ADs among elderly patients visiting an urban ED. We also explored whether there were factors associated with the existence of an AD and possible barriers to having one. Methods: This prospective study ran between October and December 2008. Individuals over the age of 70 who presented to the ED between 7 am and 7 pm, 7 days a week, were considered for enrolment. Exclusion criteria included previous enrolment and inability to provide informed consent. A team of nurses who specialize in assessment of geriatric patients administered a study instrument consisting of 28 questions. Topics included demographics, level of education, medical information, and knowledge of and attitudes toward ADs. Results: The results from 280 participants, with an average age of 80.6 years, were analyzed. Thirty-five percent of participants reported that they knew what an AD was; 19.3% of participants said they had an AD, but only 5.6% brought it to the hospital; 50.7% were interested in further information regarding ADs; and 67.9% of participants felt that it was important for physicians to know their wishes about life support. Conclusion: Knowledge of ADs among elderly patients visiting an urban Canadian ED is limited and is likely a significant factor precluding wider prevalence of ADs. There is interest in further discussion about ADs in this population group.

Availability of advance directives in the emergency department

“…In Australia in 2004, the prevalence of ADs in the general ED population was even lower (7.9%) than in our study [15]. In 2012, Gill et al published similar rates of ADs (19.3%) in the elderly urban Canadian ED population [16]. Further information on ADs in the ED was published in 2012 and focused only on senior or palliative care ED patients [17,18].…”

“…The questionnaire was based on a previously developed and validated questionnaire and translated from English into German by a qualified translator [16]. The questionnaire contained demographic parameters that were personrelated such as age, gender, nationality, family status, level of education and living situation (appendix 1).…”

“…In a 2003 survey in Australia, only 7.9% of general ED patients had a completed AD [15]. In 2012, Gill et al found a similar prevalence of ADs of 19.3% in an urban Canadian ED [16]. To our knowledge, no reliable data about the prevalence of ADs in Swiss EDs is available.…”

Availability of Advance Care Planning Documentation for Older Emergency Department Patients: A Cross-Sectional Study

“…Prior research has examined availability of ACP documents during emergency care based on patient report. [7][8][9] The only study of ACP documentation availability within the electronic health record (EHR) for emergency department (ED) patients assessed availability during hospitalization, after admission orders had been placed. 10 The purpose of this study was to characterize and compare patient-reported completion of ACP preferences and real-time availability of ACP documentation in the EHR among older adults receiving care in the ED.…”

Advance Directives in the Emergency Department

“…1 We surveyed adult emergency department patients and found very similar results to those of Gill and colleagues published in this journal. 2 Twenty-four percent of patients in our study had completed an AD compared to 19.3% in their study. We also found that a very small percentage of patients brought their AD with them to the emergency department (5% in our study compared to 5.6%) and that more patients completed their ADs with the help of lawyers (55% in our study compared to 61.5%) rather than family physicians (5% in our study compared to 19.2%).…”