Do advance directives affect end-of-life care?
Wiley
Advance directives document patient preferences for future care, including end-of-life. An analysis in the Journal of the American Geriatrics Society found that older patients with an advance directive that had been uploaded into the electronic health record at least six months before death were 25% less likely to experience potentially burdensome end-of-life care (19.9% versus 26.8%) and 31% less likely to have died in the hospital (23.2% versus 32.1%).
In the research, which was a secondary analysis of data on 2,850 US primary care patients aged ≥65 years who died during a randomized trial on the impact of advance care planning, these associations remained significant after taking into account patients’ demographics, comorbidities, and health care use. However, the associations were attenuated among patients with dementia and Black patients, emphasizing the need for greater attention and additional research on this topic in these populations.
"Advance directives are often discussed as legal documents, but our findings suggest that when these documents are accessible in the electronic health record well before death, they may be associated with less burdensome care and fewer hospital deaths among older adults," said corresponding author Danny L. Scerpella, MPH, of the Johns Hopkins Bloomberg School of Public Health.
URL upon publication: https://onlinelibrary.wiley.com/doi/10.1111/jgs.70458
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About the Journal
Journal of the American Geriatrics Society is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy — all supporting the high-quality, person-centered care essential to our well-being as we age.
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Journal
Journal of the American Geriatrics Society
Article Title
A Cohort Study of Advance Directives in Electronic Health Records and End-of-Life Outcomes
Article Publication Date
20-May-2026
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