title: Effect of advance directives on the management of elderly critically ill patients.
abstract: OBJECTIVE
  To evaluate the effects of advance directives on the management of elderly, critically ill patients.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Teaching hospital medical/surgical, noncardiac intensive care unit (ICU).
  
  
  METHODS
  The medical records of 401 patients, > or =65 yrs of age, admitted to the ICU between 1992 and 1995 were reviewed.
  
  
  METHODS
  None.
  
  
  RESULTS
  Advance directive statements included refusal of cardiopulmonary resuscitation (CPR), nutrition, intravenous medications, antibiotics, mechanical ventilation, and blood products. Nineteen (5%) patients had advance directives (study group). These patients were compared with 28 case-matched (age, Acute Physiology and Chronic Health Evaluation II score, and diagnosis) critically ill patients without advance directives (control group). We compared the following data: cost per day; number of surgical procedures; number of radiographic studies; number of central venous and pulmonary artery catheter insertions; number of complete blood counts, electrolytes, and cultures sent for laboratory testing; number of days in the ICU/hospital; and mortality rates. Statistical analysis was performed using the Student's t-test for independent means and the chi-square equation. For all observed parameters, quantitative and dichotomous differences between study and control groups were not statistically significant. Two patients received CPR, despite advance directive statements refusing this treatment.
  
  
  CONCLUSIONS
  Few critically ill seniors have advance directives. As assessed by objectively documented information, the level of care delivered to elderly ICU patients is not affected by the presence or absence of advance directive statements. Medical personnel need to be aware of whether or not patients have advance directive statements, as unauthorized CPR was administered to 11% of the patients who died with advance directives.
authors.affiliation: Department of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Cooper Hospital, Camden, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Goodman
authors.forename: M
authors.initials: M
authors.lastname: Tarnoff
authors.forename: G J
authors.initials: GJ
authors.lastname: Slotman
mesh_terms: D018806:APACHE; D016223:Advance Directives; D000368:Aged; D003422:Critical Care; D005260:Female; D005853:Geriatrics; D017048:Health Care Costs; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011787:Quality of Health Care; D016414:Resuscitation Orders; D012189:Retrospective Studies