Brief communication: the relationship between having a living will and dying in place.
BACKGROUND
Living wills, a type of advance directive, are promoted as a way for patients to document preferences for life-sustaining treatments should they become incompetent. Previous research, however, has found that these documents do not guide decision making in the hospital.


OBJECTIVE
To test the hypothesis that people with living wills are less likely to die in a hospital than in their residence before death.


METHODS
Secondary analysis of data from a nationally representative longitudinal study.


METHODS
Publicly available data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) study.


METHODS
People older than 70 years of age living in the community in 1993 who died between 1993 and 1995.


METHODS
Self-report and proxy informant interviews conducted in 1993 and 1995.


RESULTS
Having a living will was associated with lower probability of dying in a hospital for nursing home residents and people living in the community. For people living in the community, the probability of in-hospital death decreased from 0.65 (95% CI, 0.58 to 0.71) to 0.52 (CI, 0.42 to 0.62). For people living in nursing homes, the probability of in-hospital death decreased from 0.35 (CI, 0.23 to 0.49) to 0.13 (CI, 0.07 to 0.22).


CONCLUSIONS
Retrospective survey data do not contain detailed clinical information on whether the living will was consulted.


CONCLUSIONS
Living wills are associated with dying in place rather than in a hospital. This implies that previous research examining only people who died in a hospital suffers from selection bias. During advance care planning, physicians should discuss patients' preferences for location of death.
Degenholtz
Howard B
HB
Center for Bioethics and Health Law, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. degen@pitt.edu
Rhee
YongJoo
Y
Arnold
Robert M
RM
D000368:Aged; D003643:Death; D006304:Health Status; D006707:Homes for the Aged; D006738:Hospices; D017052:Hospital Mortality; D006798:Housing; D006801:Humans; D016224:Living Wills; D009735:Nursing Homes; D012189:Retrospective Studies