The personal and social context of planning for end-of-life care.
OBJECTIVE
To examine the potential facilitators of or deterrents to end-of-life planning for community-dwelling older adults, including personal (health-related and sociodemographic) and social (physician and family) influences.


METHODS
In-person interviews with older adults, telephone interviews with physicians and family members.


METHODS
Cleveland, Ohio.


METHODS
Two hundred thirty-one adults aged 65 to 99 who were aging in place, 99 of their primary care physicians, and 127 of their family members.


METHODS
Questions assessing older adults' discussions with others about end-of-life plans, implementation of advance directives, and physical (Older American Resources and Services) illness index and mental (Short Portable Mental Status Questionnaire) health status.


RESULTS
Just fewer than half of older adults had executed an advance directive and discussed their wishes with others. Only personal characteristics of elderly individuals were related to end-of-life plans, with whites, unmarried individuals, and younger adults more likely to have made preparations. Older adults' health status, as evaluated by the patient, physician, and caregiver, did not relate to the tendency to have made advance care plans. Older adults' family members were much more likely to report knowledge of advance care plans than were physicians.


CONCLUSIONS
These findings suggest that many physicians are not talking with their patients about their end-of-life wishes. Furthermore, the propensity to have such discussions may relate more to the personal preferences and level of comfort of patients, physicians, and family members than on the health status of the older adult.
Kahana
Boaz
B
Department of Psychology, Cleveland State University, Cleveland, Ohio, USA.
Dan
Amy
A
Kahana
Eva
E
Kercher
Kyle
K
D032722:Advance Care Planning / Q000639:trends*; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009820:Ohio; D019727:Proxy; D013727:Terminal Care / Q000523:psychology*