Advance directives are common for elderly trauma patients

Introduction: Expensive futile care at the end of life has been highlighted as a concern in contemporary health care. The purpose of this study is a review of the number of elderly trauma patients with advance directives prior to injury. Setting: 400 bed +/- not-for-profit general hospital and trauma center (Level II) with a family medicine residency program (only) in a rural county with a firmly established primary care network. Methods: Retrospective review of trauma registry and hospital information systems data for one year. Results: Of 1024 trauma patients, 347 (33.8%) were > 60 years of age. Mortality for the > 60 years patients was 6.25%. 13.4% of patients were on Coumadin prior to admission. 3/4 of patients > 60 years had a pre-existing chronic condition noted. 24.5% of patients (85 patients) had an advance directive executed prior to injury. 74% (20/27) of patients ≥ 60 years of age who expire had a Do Not Resuscitate order at the time of death. Conclusions: In a community with a large proportion of elderly trauma patients, at least one fourth of these patients have prepared an advance directive prior to injury. Rapid discovery of these directives following acute trauma help guide care and may limit ultimately futile interventions. No resuscitation orders have been instituted for the majority of geriatric patients who die after injury.