End-of-life decisions: influence of advance directives on patient care.

The patient records of 160 older adults who died in a community hospital were reviewed to determine the use of advance directives and evaluate their effect on the care decisions made by health care providers. Findings confirmed that the use of advance directives has not changed during the past 15 years. The documents did not seem to influence health care providers' decisions about the hospital unit in which patients were treated, the use of life-sustaining treatments, or the initiation of comfort care plans. The presence of a living will seemed to influence health care providers' decisions to write do-not-resuscitate orders more often and to use cardiopulmonary resuscitation less often for patients possessing the document. Recommendations for future research include implementation and evaluation of educational initiatives for both health care consumers and health care providers.