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TOPLINE:

Older adults with advance directives that were documented in electronic health records (EHRs) showed a lower likelihood of receiving burdensome end-of-life care and had lower rates of in-hospital death.

METHODOLOGY:

• Researchers conducted a secondary analysis of data from a cluster-randomized pragmatic trial of advance care planning in primary care practices operated by two health systems in the US.
• The analysis included 2850 patients aged 65 years or older who died between 2020 and 2023; these patients attended in-person or telehealth visits during the study period.
• Two outcomes were assessed:
  • Potentially burdensome care in the past 6 months of life that included services such as cardiopulmonary resuscitation, intubation, tracheostomy, and hemodialysis.
  • In-hospital death, defined as admission with death occurring within a day of discharge.
• EHR-documented end-of-life preferences included advance directives extracted at baseline and 12 months after study entry or uploaded at least 6 months before death.
• In total, 553 patients (mean age, 82.5 years; 56.2% female) had directives documented at least 6 months prior to death, while 2297 patients (mean age, 80.8 years; 53.6% female) did not.

TAKEAWAY:

• Patients with documented directives were less likely to receive potentially burdensome end-of-life care than those without (adjusted odds ratio [aOR], 0.75; 95% CI, 0.58-0.97).
• In-hospital death occurred in 23.2% of those with advance directives compared with 32.1% of those without a documented directive (aOR, 0.69; 95% CI, 0.55-0.88).
• Among those with directives vs those without, White patients (aOR, 0.71; 95% CI, 0.51-0.99), male patients (aOR, 0.56; 95% CI, 0.38-0.83), and those registered with the patient portal (aOR, 0.55; 95% CI, 0.38-0.82) had a lower likelihood of receiving potentially burdensome end-of-life care.

IN PRACTICE:

“Study findings underscore a demonstrable utility of ADs [advance directives] in the EHR and have potential implications for ACP [advance care planning] considerations,” the authors of the study wrote.

SOURCE:

The study was led by Danny L. Scerpella, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore. It was published online on May 20, 2026, in the Journal of the American Geriatrics Society.

LIMITATIONS:

The focus on patients who had advance directives recorded in their EHR at least 6 months prior to death may have led to including patients with more stable health or those who lived longer. The time of completion of the advance directives could not be determined. Data did not include the cause of death.

DISCLOSURES:

The authors were supported by the National Institute on Aging. They declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.