Recorded presentation

Antonios Likourezos, MA, MPH¹, Thomas Fuchs, MD¹, and Barbara Paris, MD². (1) Department of Emergency Medicine, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, 718-283-6896, alikourezos@maimonidesmed.org, (2) Department of Medicine, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219

The purpose of this retrospective cohort study was to assess the prevalence of an advance directive (AD) in the emergency department and whether elderly patients change their AD preferences over time. Elderly patients who visited the emergency department of an urban teaching medical center for 4 or 5 consecutive years from January 1, 1999 to June 30, 2003 were included in the study. Six hundred eighty three patients fulfilled the inclusion criteria. Nineteen percent (n=133) had at least one AD (group 1) and 81% (n=550) had no AD (group 2). Group 1 was significantly older than group 2 at every year of the study (year 1999 – 2003; P<.005; P<.0001; P<.0001; P<.0001; and P<.05 respectively). The prevalence of an AD from 1999 – 2003 was 2.9%, 3.1%, 4.2%, 10.5% and 13.7% respectively. AD status changed from year to year: Year 1999 and 2000, Kappa = .301; P<.0001 (n=489); Year 2000 and 2001, Kappa = .212; P<.0001 (n=683); Year 2001 and 2002, Kappa = .231; P<.0001 (n=683); and Year 2002 and 2003, Kappa = .238; P<.0001 (n=387). The most common AD was the health care proxy (74%), followed by DNR (43%), DNI (27%) and living will (7%). In conclusion, despite the life threatening events that often bring patients to the ED, it is rare for the patient to have an AD during the ED visit. It is also important to note that patients who had an AD often changed their AD preferences. This finding requires further evaluation.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• know the rate of advance directive in the ED
• list the advance directives in order of least to most prefered by the ED patients.
• State whether or not the patients change their AD preference.

Keywords: Emergency Department/Room, Elderly

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation