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R. Sean Morrison, MD; Ellen Olson, MD; Kristan R. Mertz, MD; Diane E. Meier, MD

JAMA. 1995;274(6):478-482.

Abstract
Objective.
—To investigate the accessibility of patients' previously executed advance directives during an acute hospitalization.

Design.
—Retrospective chart review.

Setting.
—A large metropolitan teaching hospital, a 514-bed skilled nursing facility, a geriatrics ambulatory care clinic, and a geriatrics group practice office.

Patients.
—One hundred fourteen geriatric patients who had previously executed an advance directive.

Main Outcome Measures.
—The medical records of 180 admissions over 3 years, 1991 through 1993, were reviewed for documentation of patients' advance directive status.

Results.
—Twenty-six percent of patients who had previously executed advance directives had their directives recognized during their hospitalization. Of the subgroup of patients who were judged not to have the capacity to make medical decisions during their admissions, 26% (14/53) had their directives recognized. When the advance directive was recognized, it appeared to influence treatment decisions in 12 (86%) of 14 cases.

Conclusions.
—Previously executed advance directives are not accessible when patients are admitted to hospitals for acute illness. When such directives are recognized, they are used to influence medical treatment decisions. Further research is needed to define and overcome barriers to this inaccessibility.

(JAMA. 1995;274:478-482)

Author Affiliations
From the Henry L. Schwartz Department of Geriatrics and Adult Development, Mount Sinai Medical Center (Drs Morrison, Mertz, and Meier), and the Jewish Home and Hospital for Aged of New York (Dr Olson), New York, NY. Dr Mertz is now with the Department of Surgery, University of Tennessee Memorial Hospital, Knoxville.

Footnotes
Correspondence to Henry L. Schwartz Department of Geriatrics and Adult Development, Box 1070, Mount Sinai Medical Center, One Gustave L Levy Pl, New York, NY 10029 (Dr Morrison).

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