Enhancing Advance Directive Completion Among Older Adults in the Geriatrics Clinic in Indiana, USA: A Quality Improvement Initiative

Abstract

Background/Objective: Death is an inevitable part of life, and ensuring high-quality end-of-life care is a critical concern. Planning for a “good death” aligns care with patients’ preferences, and advance directive (AD) discussions should begin early between patients, physicians, and families. This project aimed to increase AD completion among older adults in the Indiana University Health Primary Care (IUHPC) Geriatrics Clinic, with the goal of meeting or exceeding the national average of 46%. Methods: An intervention was implemented from September to November 2024 and from January to June 2025, focusing on patient education and strengthening patient–provider communication. Results: The initiative significantly increased AD completion, demonstrating that older adults are receptive to advance care planning once informed of its benefits. Potential influencing factors included knowledge of life-sustaining care, demographic variables, health status, awareness of dying well, and attitudes toward ADs. Conclusions: Education and communication are key to increasing AD completion rates. These findings underscore the importance of ongoing efforts to raise awareness and ensure that end-of-life care respects patients’ wishes and values.