Lack of advance directives leads to unwanted care

Nearly a quarter of older patients say they or a family member with advanced illness were pushed into unwanted or excessive treatment, according to articles published in a recent issue of Public Policy & Aging Report (PP&AR).

"Recent experience and studies make clear that well-informed individuals and their families often choose less care, in less institutional settings, often resulting in improved quality of life," Robert B. Hudson, Ph.D., and Brian W. Lindberg, MMHS, wrote in an introduction. "It has become clear that palliative care and hospice care are often not provided soon enough, and that in-depth conversations with persons with advanced illness can help articulate treatment and life-style preferences that the healthcare system has often ignored or missed."

PP&AR is published by the Gerontological Society of America. The majority of patients with advanced illness are Medicare patients, according to the articles, which also discuss programs and tools that can help patients and families with end-of-life decisions. Resources primarily focus on getting the conversation going, comprehensive advance planning tools, guides focusing on certain illnesses or decisions, and advance directive registries.

The American Medical Association recently recommended that Medicare cover end-of-life discussions, which advocates say would increase the chances that doctors would initiate those discussions with patients.

A recent report from the Institute of Medicine, "Dying in America," found providers overall are uncomfortable talking about end-of-life care and referring patients to palliative care. The report called for establishing training and certification for end-of-life care credentials.

For more information:
- read the articles (subscription required)