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Assessing Advance Directives in the Homebound Elderly

Miami Miller School of Medicine, adam.golden{at}va.gov

Martha H. Corvea, PhD

Psychology, Service, Miami VA Healthcare System

Stuti Dang, MD, MPH

Miami Miller School of Medicine

Maria Llorente, MD

Miami Miller School of Medicine

Michael A. Silverman, MD, MPH

Miami Miller School of Medicine and Miami Jewish Home and Hospital, Miami, Florida

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.

Key Words: advance directives • case management • indigent elderly • frail elderly • homebound elderly

This version was published on February 1, 2009

American Journal of Hospice and Palliative Medicine®, Vol. 26, No. 1, 13-17 (2009)
DOI: 10.1177/1049909108324359


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