Use of Advance Directives by Community-Dwelling Older Adults

• Objective: To ascertain the level of planning for endof-life medical care in a population of communitydwelling older adults and to determine if there were demographic and health-related differences among those who had taken steps toward completing advance directives. • Design: Random-digit telephone survey. • Patients and setting: 571 nonurban community-dwelling older adults aged 62 years or older. • Measures and analysis: Three levels of advance directive planning as well as demographic, socioeconomic, and health-related variables were measured. Logistic regression analyses were performed, with the levels of advance directive planning as the outcome and the descriptive variables as the predictors. • Results: 571 patients were interviewed. Forty-seven percent had discussed their wishes with a member of their family, 13.5% had discussed their preferences with their doctor, and 16.1% had written advance directives. Persons who assessed their health as poor, were single, and had greater concerns about their overall health were significantly more likely to have discussed advance directives with a family member (χ4 = 7.07, P = 0.008). Those with greater worry about their health were more likely to have spoken with a physician, and those who were married were less likely to have spoken with someone or written advance directives. • Conclusions: Although many older adults have considered end-of-life care, few have actually written advance directives. These findings suggest that physicians should initiate discussions about advance directives, particularly among married individuals, who were less likely than others to have talked about or written advance directives.