Urban/rural differences in decision making and the use of advance directives among nursing home residents at admission.
BACKGROUND
Advance directives promote patient autonomy and encourage greater awareness of final care options while reducing physician and family uncertainty regarding patient preferences.


OBJECTIVE
To investigate differences in decision making authority and the use of advance directives among nursing home residents admitted from urban and rural areas.


METHODS
A total of 551,208 admission assessments in the Minimum Data Set were analyzed for all residents admitted to a nursing facility in 2001. Using the Rural Urban Commuting Areas (RUCA) methodology and ZIP code of primary residence before admission, these residents were classified into 4 urban/rural areas.


RESULTS
Residents from rural areas were significantly more likely to have executed a durable power of attorney for health care or for financial decisions than residents admitted from the other areas, with the largest differences observed between residents admitted from urban and rural areas. Almost 6 residents in 10 from urban areas had no advance directives in place at admission compared with only 4 residents in 10 admitted from rural areas.


CONCLUSIONS
Health providers and social workers in both rural and urban areas should advise patients about the value of advance directives.
Buchanan
Robert J
RJ
College of Health and Human Services, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223-0001, USA. rjbuchan@email.uncc.edu
Bolin
Jane
J
Wang
Suojin
S
Zhu
Li
L
Kim
MyungSuk
M
D016223:Advance Directives / Q000706:statistics & numerical data*; D000368:Aged; D003657:Decision Making; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data*