Advance directives don't influence care
Neither the quantity nor quality of care given to ICU patients is dependent on whether or not advance directives were involved in their care, according to researchers in New Jersey.
What's more, few elderly patients make use of advance directives, and those who do will often find that their wishes are ignored, say a team of researchers from the University of Medicine and Dentistry of New Jersey and the Robert Wood Johnson Medical School in Camden.
Findings from the retrospective chart study, published in the April Critical Care Medicine journal, found that only 19 of 401 elderly patients admitted to the ICU at Cooper Hospital in Camden from 1992-1995 had issued advance directives. The team then compared treatment records for those 19 people with the records of 28 similar critically ill patients who did not have advance directives.
Follow-up for five years showed that five of the advance directive patients and six from the control group died in the hospital. Long-term mortality was 61% for patients without advance directive, and 74% for those with directives. Hospital expenditures for the patients with advance directives were "nearly equal" to those without directives, regardless of whether they died, says team leader Martin D. Goodman, MD.
The study found that all of the surviving patients with advance directives experienced further hospitalizations. However, only three control patients had subsequent hospitalizations. Say the authors, "Our review of the literature indicates that the increased hospitalization of surviving seniors with advance directives has not been reported previously and is an important finding of this study."
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