Relationships among advance directives, principal diagnoses, and discharge outcomes in critically ill older adults.
OBJECTIVE
The purpose of this study was to determine the relationships among advance directive status, principal diagnoses, and the discharge outcomes in community-dwelling, critically ill older adults.


METHODS
Using administrative and clinical data (n = 1673), multinomial logit regressions were used to examine the relationships among advance directive status, principal diagnoses, and discharge outcomes (in-hospital deaths, hospice discharges, and transition to institutions).


RESULTS
In the overall sample, the adjusted probability of in-hospital deaths with advance directives (12%) was lower than that without advance directives (17%; odds ratio [OR] = 0.56; p = 0.007) and the adjusted probability of hospice discharges with advance directives (11%) was higher than that without advance directives (7%; OR = 1.96; p = 0.03). Subgroup analysis showed that the magnitude of the abovementioned changes was aggregated when their principal diagnoses were a group of diseases with more difficult prognostication (circulatory and respiratory diseases) and more potential for reversibility (infectious diseases). By contrast, the magnitude of the abovementioned findings was diminished with other principal diagnoses. On the other hand, the presence of advance directives did not make a contribution to transition from communities to institutions.


CONCLUSIONS
Significantly fewer in-hospital deaths in addition to higher hospice discharges were observed with any advance directives in community-dwelling, critically ill older adults. The magnitude of these findings was aggregated when their principal diagnoses were a group of diseases with more difficult prognostication (circulatory and respiratory diseases) and more potential for reversibility (infectious diseases). By contrast, the magnitude of these findings was diminished with other principal diagnoses.
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
Ji Won
JW
Yoo
Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York.
Shunichi
S
Nakagawa
Department of Epidemiology, University of Washington, Seattle, Washington.
Sulgi
S
Kim
D016223:Advance Directives / Q000706:statistics & numerical data*; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data; D006738:Hospices; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007239:Infections / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D015233:Models, Statistical; D010166:Palliative Care / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D012140:Respiratory Tract Diseases / Q000175:diagnosis / Q000453:epidemiology; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D044465:White People