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Advance directives (ADs) were developed in the hope they would guide end-of-life decision making and reduce unwanted care when appropriate, but the effects have been mixed at best. To examine whether the effects of treatment-limiting ADs vary by U.S. region, investigators linked interview data from a national study of health and retirement with Medicare claims data for 3302 Medicare recipients who died between 1998 and 2007 (mean age at death, 83).
The 1275 people who had treatment-limiting ADs were less likely to die in a hospital (37% vs. 43%) and more likely to have stayed in a hospice (40% vs. 26%); despite those differences, spending during the last 6 months of life for those with or without ADs was similar (about $21,000). However, in …