Of 2,780 persons admitted to a long-term care (LTC) facility in the first half of 1993 and followed up in the facility through the end of 1994, 435 (16%) had advance directives and 805 (29%) had do not resuscitate orders either at admission to or subsequently while in the LTC facility. In contrast, 50 of 57 LTC residents (88%) in six Maryland community LTC facilities had either completed an advance directive or had another person complete one on their behalf. The physicians caring for the residents in an academic LTC facility affiliated with Westchester Medical Center/New York Medical College are members of the Geriatric faculty at New York Medical College and have been taught on numerous occasions to obtain advance directives for all residents admitted to the LTC facility. This article reports the prevalence of the use of advance directives among all residents currently residing in an academic LTC facility.
Key words: advance directives, long-term care facility, do not resuscitate orders, health care proxy, legal guardian.
Discussing end-of-life care with older patients is very important, as it ensures their preferences are known and they retain control over their care decisions even when they may no longer be actively involved in them. Unfortunately, these discussions do not always occur, and when they do occur, they are not always done well. There are patient and physician barriers to advanced care planning. Physicians may lack the skills necessary to accomplish the task of making decisions for future care. In this article we discuss advanced care planning, its importance as well as related challenges and barriers. We then outline a practical approach to advanced care planning for older adults.
Key words: end-of-life care, advance directives, advanced care planning, living wills, substitute decision-maker.
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