Integrative palliative care, advance directives, and hospital outcomes of critically ill older adults

Am J Hosp Palliat Care. 2012 Dec;29(8):655-62. doi: 10.1177/1049909111435813. Epub 2012 Feb 5.


Objective: To examine the associations between palliative care types and hospital outcomes for patients who have or do not have advance directives.

Method: Using administrative claims and clinical data for critically ill older adults (n = 1291), multivariable regressions examined the associations between palliative care types and hospital outcomes by advance directive status.

Results: Integrative palliative care was associated with lower hospital costs, lower adjusted probability of in-hospital deaths, and higher adjusted probability of hospice discharges. There was no difference in hospital outcomes by palliative care types in those with advance directives.

Conclusion: Significantly lower hospital costs and in-hospital deaths with higher hospice discharges were observed in integrative palliative care compared to consultative palliative care, but these findings were diminished with the presence of advance directives.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Advance Directives / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Critical Illness / therapy*
  • Female
  • Hospice Care / statistics & numerical data
  • Hospital Costs / statistics & numerical data
  • Hospital Mortality
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Palliative Care* / statistics & numerical data
  • Severity of Illness Index
  • Treatment Outcome