HELPING PATIENTS MAKE THEIR HEALTH CARE WISHES KNOWN IN ADVANCE DIRECTIVES

The Terri Schiavo case—tragic, protracted, and very public—has raised awareness of the importance of advance directives dramatically in this country. Now, physicians and other health care professionals need to encourage their patients to act on that awareness, to specify what kind of treatment they would or would not want, should illness or injury leave them unable to make their own decisions.

Fewer than 30% of Americans have advance directives, such as a living will, a durable power of attorney for health care decisions, or a Do-Not-Resuscitate order. Yet, these directives can spare chronically ill and dying patients and their families much physical and emotional suffering. In a living will, an individual can specify in writing whether he or she would want treatment involving, for example, the use of respirators, feeding tubes, or resuscitation.

A durable power of attorney for health care appoints someone, usually a relative or friend, to make medical care decisions when the patient is incapable of doing so. And a Do-Not-Resuscitate order specifies that cardiopulmonary resuscitation should not be performed if the patient’s heart, respiration, or both, cease. While it is a good idea for everyone to prepare an advance directive, it may be particularly important for patients in long-term care. Of the 13 million Americans receiving long-term care at home, or in adult day care centers, assisted living facilities, or nursing homes, 60% of them are age 65 and older.

Among other things, cognitive impairment is more common with advanced age, and can undermine an older patient’s ability to make decisions about medical care. Under federal law, hospital and nursing home staff must inform patients that they have a right to fill out an advance directive. But professionals providing long-term care in other settings, such as in private practice or in a patient’s home, should also broach the subject by asking their patients if they are familiar with advance directives and if they have the proper documents.

When discussing advance directives, health care professionals should reassure patients that the directives are not complicated, lengthy, legal documents. Individuals can obtain forms, not only from attorneys, but also from online sources, sometimes for free. There are also Web-based sources of information on laws governing advance directives, which vary from state to state. Physicians and other health care professionals should also reassure patients that they can change the terms of advance directives as long as they are competent.

Ideally, patients should discuss their wishes with their physicians and family members, and give them copies of their directives. The American Geriatrics Society’s Foundation for Health in Aging recently launched a new website, Aging in the Know: Your Gateway to Health and Aging Resources, where health care professionals can find information about advance directives and numerous other subjects for their patients.

Designed for consumers, Aging in the Know offers up-to-date information based on the American Geriatrics Society’s Geriatrics Review Syllabus (GRS) and Geriatrics At Your Fingertips (GAYF), and translates premier professional education resources on aging for a public audience. Regards,