Prevalence, effectiveness, and predictors of planning the place of death among older persons followed in community-based long term care

BACKGROUND: Little is known about whether patients plan for the site of the ir death and whether such planning is effective. OBJECTIVE: To determine the prevalence, effectiveness, and predictors of pl anning the place of death among older homebound persons followed in a commu nity-based, physician-led house call program. DESIGN: Retrospective chart review. SETTING: A geographically defined catchment area in southeast Baltimore, Ma ryland. PATIENTS: One hundred twenty-five patients who died between July 1995 and N ovember 1998 who were followed in a physician-led house call program. MAIN OUTCOME MEASURES: Presence of a plan to die in a specific place and co ncordance between planned and actual place of death. RESULTS: Eighty patients (64%) made a plan to die in a specific place, and these plans were executed successfully in 73 cases (91%). The median time b etween formulating a plan to die in a specific place and death was 36 days. In logistic regression analysis, making a plan to die in a specific place was positively associated with an advance directive of Do Not Resuscitate ( DNR) (odds ratio (OR) 11.7, confidence interval (CI) 3.7, 32.5) and negativ ely associated with the lack of an identifiable main medical problem other than being homebound (OR 0.17; CI, 0.02-0.88). CONCLUSIONS: Among a group of frail older persons living in the community, planning to die in a particular place was common and implemented successful ly most of the time. Providing physician care at home may facilitate improv ed end-of-life care for older persons.