[Patient's advance directives and appointment of a health-care proxy in elderly psychiatric patients].

In clinical practice and in research projects the presence of an advance directive or an appointment of a health-care proxy may substantially contribute to decisions of diagnostic and therapeutic interventions, if a person has lost his ability to consent. A special questionnaire was given to a non representative sample of 206 elderly inpatients suffering from different psychiatric disorders. The majority of these patients (57%) supported the necessity of such instruments. In a further 5.4% of the interviewees written documents, either advance directive or determination of a health-care proxy, were already present. However, 25% of the interviewed patients did not approve of the usefulness of these instruments and 12.5% answered that they were not able to give any decision. Among the interviewed patients, age, gender and the psychiatric disorder present were not associated with approval or refusal. However, higher education was related to the approval of advance directives. This study demonstrates that in a relatively large sample of elderly patients with psychiatric disorders approval of an advance directive and a determination of a health-care proxy is present in a substantial majority. The results suggest that there is urgent need for more intensive information of elderly people about these documents. This could contribute to a decision process about medical interventions in incapacitated persons which is in accordance with their former will.