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As the coronavirus pandemic continues in the United States, less than half of older Americans have legally stated their wishes should they become seriously ill, a new survey finds.
People 50 and older are at increased risk for severe COVID-19, and the pandemic may be an opportunity for them to discuss health care issues with their family and document their preferences if they suffer severe illness or injury from any cause, the study authors noted.
For the study, the researchers analyzed a National Poll on Health Aging online survey that was conducted in June 2020. The poll, based at the University of Michigan's (U-M) Institute for Healthcare Policy and Innovation, draws conclusions from the answers of a national sample of more than 2,000 adults aged 50 to 80.
Overall, 59% of respondents said they'd had a conversation with loved ones about their wishes if they became severely ill. The rate was higher (70%) among those older than 65.
Only 7% of the respondents said COVID-19 had motivated them to have such a conversation.
Fewer than half (46%) of respondents said they had completed at least one of two legal documents — medical durable powers of attorney and advance directives ("living wills") — that could help their loved ones make decisions for them if they can't do it for themselves.
Of the 7% who'd completed one or both forms in the early months of the pandemic, one-third said they were motivated by the pandemic. But that was just 1% of all the respondents.
At the time the poll was conducted, the higher risk of severe illness and death among older adults with COVID-19 was already known, the researchers noted.
"Our study adds to a growing body of scholarly research that supports the need for more effective, innovative and targeted approaches to ensure increased completion of advance care planning among all older adults," said Dr. Chithra Perumalswami, who worked with the poll team on the new study.
"The fact that so few of the respondents cited COVID-19 as motivation to have these critical conversations and update or complete their advance directives is concerning," added Perumalswami, who is a research fellow at the U-M Center for Bioethics and Social Sciences in Medicine, in Ann Arbor.
"It can be difficult for patients, families and providers to navigate these conversations in the hospital setting, especially when visitor restriction policies are in place to reduce the spread of COVID-19," she said in a university news release.
"It is incredibly helpful to have advance care planning completed before a person becomes seriously ill and potentially unable to communicate their preferences," Perumalswami noted.
According to poll director Dr. Preeti Malani, "Health care professionals can use the COVID-19 pandemic as a starting point for discussing advance care planning with older adults, and policymakers may want to look for opportunities to encourage more discussions within families and between patients and providers." Malani is a Michigan Medicine infectious disease physician also trained in geriatrics.
AARP offers links to each state's and territory's advance directives forms on its site.
SOURCE: University of Michigan, news release, April 6, 2021
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