The vast majority of Americans have not planned for the end of life, according to new findings published in The American Journal of Preventative Medicine. In an effort to understand why so few adults complete advance health care directives, researchers surveyed nearly 8000 people from across the U.S.
Only a quarter of respondents reported completion of an advance directive; the most frequently reported reason for not having one was lack of awareness. Completion was more common among the elderly and those with more education and higher incomes. Respondents with advance directives were also more likely to report having a chronic disease and a regular source of care. Whites were much more likely to have plans than other racial and ethnic groups.
But despite the lack of planning, nearly 70 percent reported having concerns about end of life care, including concerns about the costs, pain and comfort associated with it. One-fifth reported having no end of life concerns, and 14 percent did not know.
Advance directives are associated with significantly lower levels of Medicare spending, a lower likelihood of in-hospital deaths and higher use of hospice care, according to recent findings published in The Journal of The American Medical Association. Advance directives may take the form of a living will, durable health care power of attorney or do-not-resuscitate order.
“Current demographic trends document a growing aging population in the U.S. and an increase in the prevalence of chronic disease among adults 44 years or older,” the researchers led by Dr. Jaya K. Rao write. “During the past 20 years, issues related to end of life care, such as high-profile legal cases and debates about coverage for advance care planning discussions, have attracted national attention.” Still, most ongoing national surveys currently do not include end of life-related questions.
The researchers concluded that racial and educational disparities in advance directive completion highlight the need for education. “Given the current discussions about implementing different models of health care delivery, including the patient-centered medical home, end of life issues need to come to the forefront of planning efforts,” they write. “We hope these findings will contribute to current national conversations about end of life care.”