Association of Advance Directives Completion With the Utilization of Life-Sustaining Treatments During the End-of-Life Care in Older Patients

Abstract

Context: Evidence is mixed regarding the impact of advance directives (ADs) on the utilization of end-of-life treatments.

Objectives: This study evaluated the effect of AD on the utilization of end-of-life treatments during the last month of life in older patients.

Methods: Taipei City Hospital initiated an advance care planning program to promote AD for admitted patients in 2015. This prospective study recruited deceased older patients who completed advance care planning communication between 2015 and 2016. Multiple logistic regression was used to determine the association of AD completion with utilization of life-sustaining treatments.

Results: Of 1307 deceased older patients, overall mean age was 84.1 years and 78.7% of the subjects had AD completion. During the study follow-up period, 31 older patients received life-sustaining treatments during the last month of life, including 17 patients (1.7%) with AD completion and 14 patients (5.0%) without AD completion. After adjusting for the sociodemographic factors and co-morbidities, older patients with AD completion were less likely to receive life-sustaining treatments during the last month of life (adjusted odds ratio [AOR] = 0.32, 95% confidence interval [CI]: 0.16-0.67). Considering type of life-sustaining treatments, AD completion was associated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR = 0.21, 95% CI: 0.06-0.70) as well as intubation and mechanical ventilation support (AOR = 0.32, 95% CI: 0.14-0.70) during the last month of life in older patients.

Conclusion: AD completion was associated with a lower likelihood of receiving life-sustaining treatments during the last month of life in older patients. These findings support the continued use of AD in older population.

Keywords: Advanced directives; Taiwan; life-sustaining treatments; older patients; outcome.