DISPARITIES AMONG THOSE WITH ADVANCE DIRECTIVES IN A MEDICARE SUPPLEMENT POPULATION

Purpose: To estimate utilization rates of AD among a Medicare Supplement population. Secondary objectives included determining patient characteristics associated with having an AD and evaluating the impact of having an AD on EOL Medicare expenditures among respondents who later died.

Method: Surveys were mailed to adults 65 or older with an AARP^® Medicare Supplement Insurance Plan, insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York) in 10 states. The study sample included 26,197 respondents from 2009-2013 who answered the AD question. Multiple logistic regression analyses were utilized to determine significant characteristics associated with having an AD. Regression adjusted EOL Medicare expenditures were assessed for those with and without an AD among those survey respondents who died subsequent to survey completion.

Result: Among survey respondents, 72% had an AD. Those with an AD were significantly more likely to be female, older, non-minority, higher income, higher education, living in the south and west regions of the US and have more comorbid conditions. Following adjustments, EOL Medicare expenditures were significantly lower for those with an AD in the last 3 months (‑$11,189; p<0.01) and in the last 1 month (‑$6,091; p<0.01) prior to death.

Conclusion: Patients with an AD specifying their wishes for EOL care had significantly less Medicare expenditures during the last few months of life. This is likely due to fewer medical treatments, which has been associated with fewer aggressive treatments and improved quality of life during this difficult time. Disparities exist among those having an AD. Such populations may benefit from targeted discussions about ADs. Encouraging patients to discuss having an AD may lead to better quality of life and reduced financial and emotional burden on family.