Death panels or planning ahead?

Researchers from the University of Michigan examined the use of advanced directives to determine the impact on end-of-life care for elderly patients. The researchers looked at data on 3,746 participants who participated in the Health and Retirement Study and died between 2000 and 2006.

More than one in four (999) of the study participants lacked the decision-making capacity at the end of their lives, but fewer than half of those had completed a living will and 61 percent had assigned a durable power of attorney to oversee health care decisions, according to the study published today (April 1) in the New England Journal of Medicine.

And the researchers found that patients who had prepared advanced directives for their care were significantly more likely to receive the level of care they sought. More than 83 percent of those with living wills requesting limited care and 97 percent who asked for comfort care received care consistent with the preferences.

"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," said the study's lead author Maria Silveira, an assistant professor of Internal Medicine at Michigan and a scientist at the VA Ann Arbor Healthcare System's Clinical Management Research.

"This 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," she said. "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."

Silveira suggested those interested in advance directive planning use the website of Caring Connections, a program of the National Hospice and Palliative Care Organization.