Aligning goals with care: Advance directives in older adults with implantable cardioverter-defibrillators.
Pacing Clin Electrophysiol
; 47(5): 697-701, 2024 05.
Article
en En
| MEDLINE
| ID: mdl-38597183
ABSTRACT
BACKGROUND:
Patients ≥80 with implantable cardioverter-defibrillators (ICDs) have high rates of hospitalization and mortality, yet few have documented advance directives. We sought to determine the prevalence of advance directives in adults ≥80 years with ICDs, focusing on those with frailty and cognitive impairment.METHODS:
Prospective cohort study (July 2016-May 2019) in an electrophysiology clinic. Presence of advance directives (health care proxies [HCP] and living wills [LW], or medical orders for life-sustaining treatment [MOLST]) was determined by medical record review. Frailty and cognitive impairment were screened using 4-m gait speed and Mini-Cog.RESULTS:
77 Veterans were evaluated. Mean age 84 years, 100% male, 70% frail. Overall, 52 (68%) had an HCP and 37 (48%) had a LW/MOLST. Of 67 with cognitive testing, 36% were impaired. HCP documentation was similar among frail and non-frail (69% vs. 65%). LW/MOLST was more prevalent among frail versus non-frail (52% vs. 39%). There was no difference in HCP documentation by cognitive status (67%). A LW/MOLST was more frequent for cognitively impaired versus non-impaired (50% vs. 42%). Among 19 Veterans who were frail and cognitively impaired, 14 (74%) had an HCP and 11 (58%) had a LW/MOLST.CONCLUSIONS:
Most Veterans had a documented advance directive, but a significant minority did not. Simple frailty and cognitive screening tools can rapidly identify patients for whom discussion of advance directives is especially important.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Directivas Anticipadas
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Desfibriladores Implantables
Límite:
Aged80
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Female
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Humans
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Male
Idioma:
En
Año:
2024
Tipo del documento:
Article