Advance directives and intensity of care delivered to hospitalized older adults at the end-of-life

Background: Older adults prefer comfort over life-sustaining care. Decreased intensity of care is associated with improved quality of life at the end-of-life (EOL). Objectives: This study explored the association between advance directives (ADs) and intensity of care in the acute care setting at the EOL for older adults. Methods: A retrospective, correlational study of older adult decedents (N = 496) was conducted at an academic medical center. Regression analyses explored the association between ADs and intensity of care. Results: Advance directives were not independently predictive of aggressive care but were independently associated with referrals to palliative care and hospice; however, effect sizes were small, and the timing of referrals was late. Conclusion: The ineffectiveness of ADs to reduce aggressive care or promote timely referrals to palliative and hospice services, emphasizes persistent inadequacies related to EOL care. Research is needed to understand if this failure is provider-driven or a flaw in the documents themselves. (C) 2019 Elsevier Inc. All rights reserved.