A recent study in the New England Journal of Medicine revealed that more than one in four elderly Americans lacked the capacity to make their own medical care decisions at the end of life.

According to lead author, Maria Silveira, MD, assistant professor of internal medicine at the University of Michigan, Ann Arbor, the study underscores the need for older Americans to complete advance directives in order to “prepare themselves and their families for the often emotional and difficult medical decisions that can arise at the end of life.”

The study, which Silveira says is the first of its kind to document how many elderly adults might need others to make complex medical decisions on their behalf at the end of life, showed that 61 percent had advance directives, and of those, more than 90 percent requested either limited or comfort care at the end of life.

In addition, among those who needed decisions made but couldn’t make them themselves, 83 percent who had requested limited care and 97 percent who had requested comfort care received care that was in line with their wishes.

The subjects who had advance directives, including living wills or durable powers of attorney for health care, received the care they wanted most of the time.

“Folks with a living will or durable power of attorney for health care were less likely to die in a hospital or to get aggressive care—but that is what most of them wanted,” Silveira said in a news release.
Another finding suggests the importance of having both a living will and an appointed surrogate decision maker. “Among the handful of subjects who indicated a preference for aggressive care, half did not receive it.”

According to Silveira, there remains a great deal of misunderstanding about advance directives.

The study explains that many people do not understand that advance directives are used only when patients can’t make medical care decisions for themselves, and they can be revoked by the patient at any time, either in writing or orally.

—Meg LaPorte