Increasing prevalence of advance directive completion in a nationally representative study

Objectives: We examined if there was evidence of an increasing trend in advance directive completion and whether social stratification factors predicted advance directive completion.

Methods:  We conducted a pooled regression analysis of data from 6062 deceased individuals whose proxies were interviewed in the nationally representative Health and Retirement Study (HRS). We studied three outcomes: discussing end of life care treatment preferences, written instructions for end of life care and appointing a durable power of attorney.

Results: Advance directive completion increased over time. The only statistically significant predictor for all three types of advance directive completion was time (increase of advance directive completion between 12-22% every 2 years between interview waves) and death being expected. Completion of some types of advance directives was statistically significantly associated with cause of death, duration of illness and age at death. There was very limited support for the effect of social stratification on advance directive completion.

Conclusions: Large-scale studies need to include more health-specific factors to investigate the factors that affect advance directive completion.  While advance directive completion has increased over time, more efforts are needed to disseminate education about advance directive completion in medical as well as non-medical settings. Such efforts should be patient-centered with a focus on increasing well-being and satisfaction of the patient, caregivers and family members.