Abstract
BackgroundTotal costs associated with care for older people nearing the end of life and the cost variations related with end of life care decisions are not well documented in the literature. Healthcare utilisation and associated health care costs for a group of older Australians who entered Transition Care following an acute hospital admission were calculated. Costs were differentiated according to a number of health care decisions and outcomes including advance directives (ADs).MethodsStudy participants were drawn from the Coaching Older Adults and Carers to have their preferences Heard (COACH) trial funded by the Australian National Health and Medical Research Council. Data collected included total health care costs, the type of (and when) ADs were completed and the place of death. Two-step endogenous treatment-regression models were employed to test the relationship between costs and a number of variables including completion of ADs.ResultsThe trial recruited 230 older adults with mean age 84 years. At the end of the trial, 53 had died and 80 had completed ADs. Total healthcare costs were higher for younger participants and those who had died. No statistically significant association was found between costs and completion of ADs.ConclusionFor our frail study population, the completion of ADs did not have an effect on health care utilisation and costs. Further research is needed to substantiate these findings in larger and more diverse clinical cohorts of older people.Trial registrationThis study was registered on 13/12/2007 with the Australian New Zealand Clinical Trial Registry (ACTRN12607000638437).
Highlights
Total costs associated with care for older people nearing the end of life and the cost variations related with end of life care decisions are not well documented in the literature
Participants needed to be identified from consecutive admissions to a single residential Transition Care (TC) facility, able to communicate in English and nominate an informal carer willing to participate in the study
Our study showed that 34 % of decedents had completed advance directives (ADs), which is comparable to results from similar studies that report the proportion of deaths preceded by completion of any end of life document range between 23 % (Italy) and 51 % (Switzerland) [68]
Summary
Total costs associated with care for older people nearing the end of life and the cost variations related with end of life care decisions are not well documented in the literature. In recent years in Australia, there has been growing interest in end of life care plans or Advance Directives (ADs) to help individuals to make their preferences known when they no longer have an ability to do so [17]. Advance directives are documents that provide the opportunity for people to make instructional decisions and/or nominate SDMs for the future ensuring that their preferences can be known and respected at the time of incapacity [17]. Non-legal ADs are usually care plans created for a person during a process whereby individuals in consultation with health care providers and relatives, describe their personal values and life goals and these help inform healthcare and lifestyle decisions at times of future health care need [22]. Documenting ADs enables alignment of decisionmaking to support personal autonomy of individuals with decision-making by families and other decisionmakers and has been demonstrated to increase satisfaction with care [23,24,25]
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