Advance Directives Among Patients In A House Call Program

Abstract

Background: Advance medical directives (the living will and the durable power of attorney) provide a means for competent persons to influence treatment decisions in the event of serious illness and loss of competence. Advance directives are currently underused. We examined the awareness and number of advance directives among elderly homebound patients.

Methods: In a house call program for 120 elderly patients, a standardized telephone interview was conducted with 116 patients or their caregivers. They were asked whether they had a will, a living will, or had assigned a durable power of attorney. Those without advance directives were asked whether they knew what each directive was. Demographic and medical data were assessed by interview and chart review.

Results: More than 60 percent of the patients knew about the durable power of attorney, and more than one-half had assigned a durable power of attorney. About one-third knew about living wills, but only 5 percent had one. One-third of the patients had a will.

Conclusions: Advance directives are important mechanisms whereby patients can extend autonomy over the circumstances of dying. Physicians and patients should consider and discuss the issues that surround treatment in the event of terminal illness or permanent unconsciousness.