A quarter of older people lack decision making capacity

More than a quarter of older people lack the capacity to make their own medical decisions at the end of life, according to a study from the US.

However those who prepare advance directives, including living wills and durable powers of attorney, usually receive the care they want.

The findings are based on a study of 3,746 older Americans that was published in the New England Journal of Medicine.

“Prior to our study, no one knew how many elderly adults might need others to make complex medical decisions on their behalf at the end of life,” said the study’s lead author, Dr Maria Silveira from the University of Michigan.

“Our research shows that a substantial number of older adults need someone else to make decisions about whether aggressive, limited, or comfort care should be provided at the end of life.

“This study underscores the need to prepare oneself and one’s family for the often emotional and difficult medical decisions that can arise at the end of life.

“It also suggests that the time spent [crafting] a living will and [appointing] a durable power of attorney for healthcare can be worthwhile.”

The study subjects were older Americans, living in their own homes or in aged care facilities, who died between 2000 and 2006.

Sixty-one per cent of the participants in the study had advance directives and more than 90 per cent of them requested limited care or comfort care at the end of life.

Eighty-three per cent of the people who requested limited care and 97 per cent of those who requested comfort care had their wishes met.

“Folks with a living will or durable power of attorney for health care were less likely to die in a hospital or to get aggressive care – but that is what most of them wanted,” said Dr Silveira.