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Relationships among advance directives, principal diagnoses, and discharge outcomes in critically ill older adults

Published online by Cambridge University Press:  15 August 2012

Ji Won Yoo ,
Shunichi Nakagawa  and
Sulgi Kim
Ji Won Yoo*
Affiliation:
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan Department of Internal Medicine, Korea University, Seoul, Republic of Korea
Shunichi Nakagawa
Affiliation:
Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York James J. Peters Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center, Bronx, New York
Sulgi Kim
Affiliation:
Department of Epidemiology, University of Washington, Seattle, Washington
*
Address correspondence and reprint requests to: Ji Won Yoo, University of Michigan Medical School – Internal Medicine, 300 North Ingalls Building, Room 932, Ann Arbor, MI 48109-2007. E-mail: yoojiw@trinity-health.org
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Abstract

Objective:

The purpose of this study was to determine the relationships among advance directive status, principal diagnoses, and the discharge outcomes in community-dwelling, critically ill older adults.

Method:

Using administrative and clinical data (n = 1673), multinomial logit regressions were used to examine the relationships among advance directive status, principal diagnoses, and discharge outcomes (in-hospital deaths, hospice discharges, and transition to institutions).

Results:

In the overall sample, the adjusted probability of in-hospital deaths with advance directives (12%) was lower than that without advance directives (17%; odds ratio [OR] = 0.56; p = 0.007) and the adjusted probability of hospice discharges with advance directives (11%) was higher than that without advance directives (7%; OR = 1.96; p = 0.03). Subgroup analysis showed that the magnitude of the abovementioned changes was aggregated when their principal diagnoses were a group of diseases with more difficult prognostication (circulatory and respiratory diseases) and more potential for reversibility (infectious diseases). By contrast, the magnitude of the abovementioned findings was diminished with other principal diagnoses. On the other hand, the presence of advance directives did not make a contribution to transition from communities to institutions.

Significance of results:

Significantly fewer in-hospital deaths in addition to higher hospice discharges were observed with any advance directives in community-dwelling, critically ill older adults. The magnitude of these findings was aggregated when their principal diagnoses were a group of diseases with more difficult prognostication (circulatory and respiratory diseases) and more potential for reversibility (infectious diseases). By contrast, the magnitude of these findings was diminished with other principal diagnoses.

Keywords

Critical careHealth services for the agedAdvance directivesDiagnosis-related groups
Type
Original Articles
Information
Palliative & Supportive Care , Volume 11 , Issue 4 , August 2013 , pp. 315 - 322
Copyright
Copyright © Cambridge University Press 2012 

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