Assessing advance directives in the homebound elderly.
We studied the prevalence of specific barriers that prevent indigent homebound older adults from obtaining advance directives and tested the effectiveness of clinical reminders for lowering the number of clients without advance directives. Case managers interviewed 1569 clients to determine whether they had an advance directive. All 530 clients without advance directives were contacted 3 months later to determine if advance directives had been obtained. Clients who still did not have advance directives were asked to list 1 or more reasons they did not have advance directives. About 57.8% of the barriers identified may reflect reluctance on the part of clients to address their own mortality. Reminders by the case managers were ineffective at lowering the number of homebound older adults without advance directives. Further studies are needed to identify and design strategies for convincing this population of homebound elderly to establish advance directives.
Geriatric Research, Education, and Clinical Center, Miami VA Healthcare System, 1201 NW 16th Street, Miami, FL 33125, USA. adam.golden@va.gov
Adam G
AG
Golden
Martha H
MH
Corvea
Stuti
S
Dang
Maria
M
Llorente
Michael A
MA
Silverman
D016223:Advance Directives / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D002755:Choice Behavior; D003657:Decision Making; D005260:Female; D018577:Homebound Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D028701:Patient Rights; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods*; D016312:Treatment Refusal / Q000706:statistics & numerical data*