Two new studies show the importance of planning your end of life care. In the first, researchers in Australia followed hundreds of patients who were older than 80 and and had been admitted to the hospital. Almost half had received help with advanced care planning.

Business Week reports that “Within six months, 56 of the patients died. The study authors found that end-of-life wishes were known and followed in 86 percent of patients who received the planning assistance, but only 30 percent of the others.”

The study is particularly relevant because other research finds that elderly have a better than 25 percent chance that they will need someone else to make their health care decisions. According to The Washington Post, “researchers looked at how often the elderly reach the point where they can’t make their own care decisions near the end of life – usually because of dementia, a stroke or a debilitating illness.” The study found that “30 percent needed a treatment decision made before death but [the patients] couldn’t do it themselves.”

Interestingly, the study also found that just 2 percent had wanted aggressive care. Almost everyone wanted limited or comfort care. This is significant because without clear instructions, doctors and hospitals will nearly always err on the side of aggressive care.

In other words, doctors and hospitals will provide medical care that 98 percent of people don’t want, not because they don’t follow people’s wishes but simply because it seems better, absent instructions otherwise, to keep someone alive rather than let him die.

Yet the AP reports that “most Americans still don’t draft the legal documents that spell out how far caregivers should go to keep them alive artificially.” The article continues,

End-of-life experts estimate 20 percent to 30 percent of U.S. adults have advance directives, the same as before the [Terry] Schiavo case [which brought the issue to national attention five years ago]. Even in polls of older Americans, who fill out such forms at higher rates, there is little if any change from 2005.”

End of life planning shouldn’t be simply about signing a document stating what you do and do not want at the end of your life. “It’s an ongoing conversation,” said Sally Hurme, who works on consumer health education for AARP. “Your views may change, your health circumstances may change and you need to keep your family up to date.”

Plus, you simply cannot know what your health and medical options may be. As medicine advances, treatments change, and what seems to be aggressive care one year may become standard care the next. End of life planning is not about asking doctors to “hook me up” or to “pull the plug.” Instead it involves ongoing and repeated conversations with doctors and–especially–loved ones about your desires at the end of life. Do you want to be in the hospital or at home. Do you want to be conscious and alert? Do you want to achieve something by the end of your life, a goal or a dream? Or would you rather spend your energy recovering from treatments and surgeries that may lengthen your life?

Often, these are values questions. To what degree do you value life itself versus time with family or opportunities for spiritual growth in preparation for eternity? These aren’t just questions about health care treatments, they’re expressions of our deepest beliefs being played out at one of the most significant times in our lives.

Start to think about your end of life decisions at Caring Connections.


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