Vol. 39 No. 2 February 2010 Schedule with Abstracts 423

Cross-tabulations compared patient dischargeoutcomes based on transfer status to theAPCU. PCCS patient unit costs for ICU, medi-cal-surgical units, and the APCU were alsocompared.IV. Results. The PCCS has documented appropri-ateness for transfer to the APCU for 5,985 pa-tients. Thirty percent transferred to the APCUfrom an inpatient unit or the ER, and 18% werenot appropriate for the APCU. The other 52% ap-propriate for care on the APCU were not trans-ferred due primarily to lack of bed availability.Although patients who expired or were dis-charged to hospice care were more likely to trans-fer to the APCU, only 40% of those who expiredand 29% of patients discharged to hospice weretransferred to the APCU. APCU unit costs average$136 less than other medical-surgical units and$755 less than ICUs per day.V. Conclusion. Although the PCCS provides inpa-tient follow-up, a significant number of dyingand hospice patients do not benefit from the24/7 palliative care team and inviting family en-vironment on the APCU. For the hospital thismeans lost opportunities to reduce costs, partic-ularly for patients who would transfer from anICU.VI. Implications for Research, Policy, or Practice. AnAPCU supports the objectives of a PCCS andserves to comprehensively meet the palliativecare needs of dying patients (and their families)and patients with advanced illness. In the ab-sence of APCU bed availability, staff on otherunits should be prepared to provide palliativeand end-of-life care.

Do Older Adults with Completed AdvanceDirectives Really Understand Them? (704)Cody Andrews, BA, University of Texas Health Sci-ence Center at San Antonio, San Antonio, TX.Jignesh Patel, MD, University of Texas at San An-tonio, San Antonio, TX. Sandra Sanchez-Reilly, University of Texas Health Science Centerat San Antonio and the South Texas VeteransHealth Care System, San Antonio, TX.Jeanette Ross, MD, University of Texas Health Sci-ence Center at San Antonio, San Antonio, TX.(All speakers have disclosed no relevant finan-cial relationships.)

Objectives1. Discuss the most common reasons why older

adults might complete advance directives.

2. Discuss the attitudes and knowledge of ad-vance directives in older adults who have com-pleted them.

I. Background. Everyone can determine/docu-ment the medical care they will receive if unableof making decisions using advance directives(AD). This is crucial given increasing numbersof older adults (OA) with chronic diseases. How-ever, AD completion rates remain low.II. Research Objectives. To explore the knowledge/at-titudes toward AD among OA who completed AD.III. Methods. OA with AD receiving medical carein a geriatric clinic were recruited. Participantswere interviewed to assess their knowledge/atti-tudes toward AD. Interviews were audio-recorded, transcripts analyzed for commonthemes using qualitative analysis.IV. Results. Twenty two subjects were interviewed.A total of 59.1% (13/21) had received informa-tion on AD at some point, and 48% (7/13) re-ceived it in hospitals. Reasons for completingAD included: giving others power of decision-making (4/17), deteriorating health (3/17),and decisions documentation (3/17). A totalof 18.1% (4/22) had discussed their end-of-lifepreferences with their physicians, though 63%(14/22) had discussions with families. All partic-ipants believed that AD would help receive pre-ferred end-of-life care (21/21). However 14%(3/21) believed their end-of-life treatmentwould be restricted due to AD. Two-thirds (14/21) believed that AD would prevent costly med-ical expenses for families. 13.6% (3/22) wereunaware of having AD though 2/3 rememberedafter prompting. Participants in general wereconfused with AD terminology: 4/22 did notknow the term advance directive, of those 89%(16/18) did know more specific terms livingwill, power-of-attorney. There was also confusionbetween medical and legal power-of-attorney.V. Conclusion. Despite conducting interviews amongAD completers, there was still confusion about AD,mostly terminology. OA were knowledgeable aboutthe overall purposes of AD. Despite that desire tohave end-of-life wishes respected was the main rea-son to complete AD, only few OA had discussedpreferences with physicians.VI. Implications for Research, Policy, or Practice. De-spite efforts to increase AD completion inhealthcare settings more emphasis need to bedone in educating OA about AD, and encourag-ing discussions between patients, healthcareproviders and their families.