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50+: Live Better, Longer

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Advance Directives Are Usually Followed

Most People With Living Wills or Health Care Proxies Have Their Treatment Wishes Honored

Honoring Advance Directives continued...

One surprise: 67.6% of those who lacked decision-making ability had advance directives -- either a living will, health care proxy, or both.

So were their wishes followed?

''What we found was, the agreement depended on what the patient wanted," Silveira tells WebMD. "Almost everyone who wanted comfort care got it." If they asked for limited care -- not the most aggressive but beyond comfort care -- 83.2% got it, she found.

Only half of the 10 people who requested ''all care possible,'' the most aggressive approach, got it. But Silveira says that was sometimes because ''all care possible'' couldn't be given.

One example: A person with very low blood pressure who wanted dialysis if needed would not be given it, she says, as the dialysis would lower their pressure more and perhaps hasten death.

The health care proxy wish was nearly always carried out, she found. ''Thirty percent of the [3,746] older adults needed surrogate decisions," she says. "When they appointed a durable power of attorney for health care, 92% of the time they got the decision maker they chose.''

Silveira's bottom line? "No one is claiming these things are perfect,'' she says of advance directives. "But they are better than nothing. They are meant to make a difficult situation a little bit less so for the family. Without them, what else do we have?"

Advance Directives: Second Opinion

Not everyone agrees entirely with the study's conclusions. Muriel Gillick, MD, a clinical professor of population medicine at Harvard Medical School and a practicing physician, wrote an editorial to accompany the study. She finds a health care proxy helpful but criticizes the living will as ''mostly useless.''

Part of the problem, she says, is that the documents spell out preferences for specific interventions, but that a patient can't really make informed choices until he or she knows the pros and cons of the treatments, and that a patient's preference may change once the condition is real, not theoretical.

The study method could have affected the results. "The study relies on the memories of friends or family members, an average of a year after the person's death. One has to question the accuracy in terms of the details of those memories," Gillick tells WebMD.

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