Advance directives are not widespread among the elderly. This was revealed by a cross-sectional study of 11 German nursing homes performed by Sarah Sommer and her colleagues and presented in the latest issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2012; 109(37): 577). In the year 2007, only 11% of the nursing home residents had a personally signed advance directive, while a further 1.4% had a proxy directive, i.e., a document signed not by the resident but by a representative.
Few of the advance directives made any provision for an acute health crisis. Therefore, many directives are of little help in deciding what treatment to give in such circumstances. Agreements of the nursing staff, who ought to be aware of the directives and their contents, also left much to be desired. For 14 of 23 residents, for example, there had been no discussion of whether they should be resuscitated.
The authors surmise that the Advance Directives Act of 2009 will not bring about any substantial or lasting improvement in this state of affairs, because it neither provides incentives nor foresees resources for active guidance.