title: Advance directives for older adults in the emergency department: a systematic review.
abstract: BACKGROUND
  It has been more than two decades since the passage of the Patient Self-Determination Act (PSDA) of 1991, an act that requires many medical points of care, including emergency departments (EDs), to provide information to patients about advance directives (ADs).
  
  
  OBJECTIVE
  The study objective was to determine the prevalence of ADs among ED patients with a focus on older adults and factors associated with rates of completion.
  
  
  METHODS
  We searched PubMed, Embase, PsycINFO, CINAHL, Web of Science, Medline, and the Cochrane Library. Articles were selected according to the following criteria: (1) population: adult ED patients; (2) outcome measures: quantitative prevalence data pertaining to ADs and factors associated with completion of an AD; (3) location: EDs in the United States; and (4) date: published 1991 or later.
  
  
  RESULTS
  Of the 258 references retrieved as a result of our search, six studies met inclusion criteria. Rates of patient-reported AD completion ranged from 21% to 53%, while ADs were available to ED personnel for 1% to 44% of patients. Patients aged ≥65 years had ADs 21% to 46% of the time. Sociodemographics (e.g., older age, specific religion, white or African American race, being widowed, or having children) and health status related variables (e.g., poor health, institutionalization, and having a primary care provider) were associated with greater likelihood of having an AD.
  
  
  CONCLUSIONS
  Published rates of AD completion vary widely among patients presenting to U.S. EDs. Patient sociodemographic and health status factors are associated with increased rates of AD completion, though rates are low for all populations.
authors.affiliation: 1University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Oulton
authors.affiliation: 2Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona.|3Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona.|4Arizona Center on Aging, University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: Suzanne Michelle
authors.initials: SM
authors.lastname: Rhodes
authors.affiliation: 3Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona.|5Arizona Health Sciences Library, University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: Carol
authors.initials: C
authors.lastname: Howe
authors.affiliation: 3Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona.|4Arizona Center on Aging, University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: Mindy J
authors.initials: MJ
authors.lastname: Fain
authors.affiliation: 3Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona.|4Arizona Center on Aging, University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: Martha Jane
authors.initials: MJ
authors.lastname: Mohler
mesh_terms: D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D006801:Humans; D014481:United States