New data suggest that more and more older Americans are completing living wills and designating health care surrogates for end-of-life medical decisions — a development some experts say points to an increasingly relaxed attitude toward death among the aging population.
Dr. Maria Silveira, a palliative care specialist and lead author of the new study, said in a press release that the percentage of elderly Americans making these preparations has now reached 72 percent — a nearly 100-percent increase since 2000. However, the trend appears to have had little effect on hospitalization and mortality rates.
"Given the aging population, there's been a great push to encourage more people to complete advance directives with the idea that this may increase hospice care and reduce hospitalization for patients during the last six months of life," Silveira explained. "We found that while there's an upward trend in creating these documents, it didn't have much bearing at all on hospitalization rates over the decade. Indeed, hospitalization rates increased during the decade, rather than go down.”
“These are really devices that ensure people's preferences get respected, not devices that can control whether a person chooses to be hospitalized before death,” she added.
The study, which is published in the Journal of the American Geriatrics Society, used data from the Health and Retirement Study — a nationwide sample of older Americans put together by the University of Michigan Institute for Social Research. Silveira and colleagues looked at statistics on living wills, reported preferences for life-support treatment, appointment of health care surrogates, and other end-of-life preparations.
The team suggests that the rising trend may indicate a willingness to ease the burden on friends and family members when it comes to medical treatment and related matters. "People seem more comfortable having 'the talk' about those dire ‘what-if’ scenarios and death in general," Silveira told reporters. "It's become part of the routine check list in getting affairs in order, especially for older adults.
A possible explanation for the recent surge is the increased media exposure of ethically-charged end-of-life stories. Earlier this year, a Texas hospital galvanized news outlets with its decision to use a state statute to override a brain dead pregnant woman’s Do-Not-Resuscitate order. Another example is 13-year-old Jahi McMath, who was declared brain dead following a tonsillectomy.
"As a physician, when you help a patient prepare for the end of life, it depends on the patient's age, their medical conditions, and their lifestyle," Silveira said. "As a family, it can never be too early to talk about these issues."
Source: Silveira M, et al. Advance Directive Completion by Elderly Americans: A Decade of Change. Journal of the American Geriatrics Society. 2014.