When Living Wills go Missing: Associations With Hospice Use and Hospital Death Using National Longitudinal Data

Despite documented benefits of advance care planning (ACP), understandings about the impact of advance directives (AD)—critical steps in the ACP process—remain limited. As a type of AD, living wills (LWs) are often misplaced or forgotten about. This study explores the prevalence of missing LWs among older adults in the U.S. and its association with in-hospital death and hospice care use. Analyses are based on 692 participants who responded to LW completion questions in the 2016 Core and 2018 wave of the Health and Retirement Study Nearly a fifth of American older adults age 65+ had an LW that went missing. Stepwise logistic regression results show that completed LWs confirmed by both individuals and their proxies were associated with increased hospice use and fewer hospital deaths. Individuals whose LWs went missing still had better end-of-life care than those who did not have an LW.