Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #107854

Antonios Likourezos, MA, MPH¹, Thomas Fuchs, MD¹, Donald B. Chalfin, MD, MS², and Steven Davidson, MD, MBA¹. (1) Department of Emergency Medicine, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, 718-283-6896, alikourezos@maimonidesmed.org, (2) Division of Critical Care Medicine, Montefiore Medical Center, 1825 Eastchester Rd, Bronx, NY 10461

The purpose of this retrospective cohort study was to determine in 351 randomly selected Emergency Department (ED) geriatric patients the potential demographic, epidemiological and clinical differences between those with and without an advance directive (AD). Medical records were reviewed for a) demographics, b) admission location, c) severity of illness, d) presence and type of AD, and e) disposition and resource utilization. Twenty four patients had and 327 did not have an AD. Of the 24 patients with an AD, 37.5% had only a health care proxy (HP), 33.3% had only a do not resuscitate order (DNR), 8.3% had only a living will (LW), 4.2% had both a DNR and HP, and 16.7% had a HP and LW. More AD patients were male (P<.005); came from a nursing home (P<.0001); presented to the ED for a severe illness or injury (P<.0001); had laboratory exams for complete blood counts (P<.005), electrolytes (P<.005), and microbiological cultures (P<.001); initiation of IV fluids (P<.0001); stayed longer in the ED (P<.05); and were admitted to the hospital (P<.0001). Of the patients admitted to the hospital, 9.1% of the AD group and 4.8% of the non-AD group were admitted to intensive care unit (P=.326). Additionally, a similar percentage, 4.5% and 4.8% respectively expired in the hospital (P=1.000). This pilot study suggests that demographic and clinical differences exist between the AD and non-AD ED patients. Further study is necessary to more conclusively determine the relationship between advance directives, the care provided, and the resources expended in ED patients.

Learning Objectives: At the conclusion of the session, the participant will be able to

• List the type of Advance Directives and identify the most frequet utilized AD
• Recognize the demographic, epidemiological and clinical differences between elderly patients with and without an Advance Directive who present to the Emdergency Department.
• Evaluate the resource utilization of patients with and without an Advance Directive.

Keywords: Aging, Ethics

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.