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Research on Aging, Vol. 27, No. 6, 659-691 (2005)
DOI: 10.1177/0164027505279722

Advance Care Planning in a Frail Older Population

Patient Versus Program Influences

Helena Temkin-Greener

Diane L. Gross

University of Rochester School of Medicine & Dentistry

Dana B. Mukamel

University of California, Irvine

This study examines the process of advance care planning in managed care programs serving the frail elderly and assesses the contributions of individual versus program characteristics on choices made. Data about 3,548 participants in nine programs were obtained. Logistic regressions examine associations between independent variables and end-of-life treatment choices. Interviews with the programs’ medical directors augment quantitative analysis. When all of the known participant characteristics are accounted for, substantial amount of variation attributable to the program-indicator variable remains. Program effect explains 36% of the variation in do-not-resuscitate choice, 66% in the choice of artificial feeding, and 50% relating to the presence of health care proxy. The variation in treatment choices attributable to the program of enrollment and the interviews with the medical directors suggest that provider practice styles are important in determining patients’ choices at the end of life. Interventions to enhance advance care planning should target providers of care.

Key Words: advance directives • end of life • PACE • managed care • long-term care


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 J. Gerontol. A Biol. Sci. Med. Sci.Home page
H. Temkin-Greener, A. Bajorska, and D. B. Mukamel
Variations in Service Use in the Program of All-Inclusive Care for the Elderly (PACE): Is More Better?
J. Gerontol. A Biol. Sci. Med. Sci., July 1, 2008; 63(7): 731 - 738.
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