Many people have not completed advance directives, have completed directives that do not provide clear direction, or have appointed proxies who are unlikely to actually know their past wishes.
One of the few randomised controlled trials [ 4] of ACDs in LTC, conducted in Canada, found that the majority of residents completing directives chose to remain in the LTC facility and receive palliative care.
If the public understands how to complete advance directives and the benefits of doing so, the completion rates and the validity and utility of the completed advance directives may increase with corresponding benefits for both the individuals and the health care system.
Gerontologists, elder attorneys and experts of all stripes are forever urging people to complete advance directives.
Some patients who complete advance directives, for example, explicitly decline hip surgery like that Mr. Reagan underwent, as well as antibiotics to treat infections.
As with many degenerative diseases, the progression of Alzheimer's has implications for how patients choose among treatments as they complete advance directives.
For example, some jurisdictions do not allow minors to complete advance directives while others do.
For example, black Americans make up a higher percentage of urban than rural populations, and complete advance directives at a lower rate than white Americans.
The authors of these different studies have speculated that observed differences were due to cultural preferences, with reluctance among some immigrant subpopulations to utilize hospice services and complete advance directives.
Studies consistently show that, although competent adults wish to be involved in making decisions about their health care, so that their preferences can be respected, and although they trust family members and others to be substitute decision-makers, they fail to complete advance directives or communicate their preferences for end-of-life care to family members or significant others.
