More People Are Making Living Wills

By Jane Farrell

The number of older people who have living wills has nearly doubled in recent years, researchers have found. The change indicates that millions of people are less timid about discussing the complicated, frightening issues surrounding end-of-life medical treatments.

Investigators from the University of Michigan and the Veterans Affairs Ann Arbor Health Care System found that the percentage jumped from 47 percent in 2000 to 72 percent in 2010.

At the same time, there was little difference in hospitalization rates or hospital deaths, the experts found. Advocates of living wills say that such documents help when people are hospitalized or near death.

The study was published in the Journal of the American Geriatrics Society.

“Given the aging population, there’s been a great push to encourage more people to complete advance directives with the idea that this may increase hospice care and reduce hospitalization for patients during the last six months of life,” says lead author and palliative care specialist Maria Silveira, M.D., M.A., M.P.H, researcher with the VA Ann Arbor Healthcare System and assistant professor in the Department of Internal Medicine at the U-M Medical School.

“We found that while there’s an upward trend in creating these documents, it didn’t have much bearing at all on hospitalization rates over the decade.  Indeed, hospitalization rates increased during the decade, rather than go down. These are really devices that ensure people’s preferences get respected, not devices that can control whether a person chooses to be hospitalized before death.”

The increase in advance directives indicates that people are less timid about broaching end-of-life planning and talking about death with loved ones, she said.

People seem more comfortable having ‘the talk’ about those dire “what-if” scenarios and death in general,” Silveira said. “It’s become part of the routine check list in getting affairs in order, especially for older adults. People want to ease the burden upon their loved ones who will undoubtedly face difficult decisions when it comes to handling finances, medical treatment and other matters.”

In reaching their conclusion, the researchers analyzed statistics from the Health and Retirement Study, a nationally-representative sample of older Americans that is conducted by the U-M Institute for Social Research for the National Institute of Aging.

The recent study found that most people both appointed a surrogate and left their treatment preferences known.  Among those who only had completed one document, more chose to appoint a surrogate than leave their treatment preferences in writing.

“Identifying the person you trust to make these types of medical decisions isn’t as emotional a decision as deciding whether you’d want aggressive treatment or hospice care if you’re dying,” Silveira says. “It’s much more difficult to make decisions about treatment because it often depends on unforeseeable factors such as how sick the person is, whether his or her brain is working and chances