• Yung-Feng Yen, Li-Ying Huang, Hsiao-Yun Hu, Wen-Jung Sun, Ming-Chung Ko, Ya-Ling Lee, Sheng-Jean Huang, and Dachen Chu.
• Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
• J Pain Symptom Manage. 2018 Feb 1; 55 (2): 265-271.

ContextEvidence is mixed regarding the impact of advance directives (ADs) on the utilization of end-of-life treatments.ObjectivesThis study evaluated the effect of AD on the utilization of end-of-life treatments during the last month of life in older patients.MethodsTaipei City Hospital initiated an advance care planning program to promote AD for admitted patients in 2015. This prospective study recruited deceased older patients who completed advance care planning communication between 2015 and 2016. Multiple logistic regression was used to determine the association of AD completion with utilization of life-sustaining treatments.ResultsOf 1307 deceased older patients, overall mean age was 84.1 years and 78.7% of the subjects had AD completion. During the study follow-up period, 31 older patients received life-sustaining treatments during the last month of life, including 17 patients (1.7%) with AD completion and 14 patients (5.0%) without AD completion. After adjusting for the sociodemographic factors and co-morbidities, older patients with AD completion were less likely to receive life-sustaining treatments during the last month of life (adjusted odds ratio [AOR] = 0.32, 95% confidence interval [CI]: 0.16-0.67). Considering type of life-sustaining treatments, AD completion was associated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR = 0.21, 95% CI: 0.06-0.70) as well as intubation and mechanical ventilation support (AOR = 0.32, 95% CI: 0.14-0.70) during the last month of life in older patients.ConclusionAD completion was associated with a lower likelihood of receiving life-sustaining treatments during the last month of life in older patients. These findings support the continued use of AD in older population.Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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