Living will, resuscitation preferences, and attitudes towards life in an aged population.
BACKGROUND
The growth of life-sustaining medical technology and greater attention to medical care at the end of life have provoked interest in issues related to advance care planning.


OBJECTIVE
To investigate how having a living will (LW), resuscitation preferences, health condition, and life attitudes are related in home-dwelling elderly people.


METHODS
In a cross-sectional descriptive study, detailed assessments were made of 378 home-dwelling elderly individuals participating in a cardiovascular prevention study (DEBATE Study). The participants were inquired about a preexistence of a written document (LW) concerning life-sustaining care, preferences of cardiopulmonary resuscitation (CPR) in their current situation, and attitudes towards life. General health, physical and cognitive functioning, the presence of depression, and quality of life were also assessed.


RESULTS
Forty-four of the 378 participants (12%) had a LW. As compared with those without one (n = 334), there were more women [82% (36/44) vs. 63% (210/334)] and widows [57% (25/44) vs. 41% (135/334)] among those with a LW. They were also more educated and considered their health to be better. Despite having a LW, 46% (20/44) of them preferred CPR in their current condition, a proportion not statistically different from the 58% (194/334) of the individuals without a LW. In the whole sample, 39% (149/378) of the individuals preferred to forgo CPR. As compared with those preferring CPR, they were older, more often women, and widowed. Participants preferring to forgo CPR had a poorer quality of life, were more lonely, and showed signs of depression more often than those preferring CPR. The preference to forgo CPR was related to attitudes towards life regardless of physical or cognitive functioning.


CONCLUSIONS
Having a LW does not reduce the reported preference of CPR which is related more to current mental status and life attitudes. In-depth assessment of the patient's preferences should be performed in any comprehensive care plan.
Laakkonen
Marja-Liisa
ML
Helsinki City Hospital Koskela, Helsinki, Finland. marja-liisa.laakkonen@hel.fi
Pitkala
Kaisu H
KH
Strandberg
Timo E
TE
Berglind
Saila
S
Tilvis
Reijo S
RS
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over / Q000523:psychology*; D001290:Attitude; D001294:Attitude to Health; D016887:Cardiopulmonary Resuscitation / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D016224:Living Wills / Q000523:psychology*; D016015:Logistic Models; D008297:Male; D011788:Quality of Life / Q000523:psychology*; D018709:Statistics, Nonparametric