Advance Care Planning in Healthy Older Adults

Abstract

This article reports the secondary analysis of a qualitative study that examined the beliefs, values, lifestyles and health status of adults at least 75 years old (N=18). An unanticipated finding was that all participants who self-identified as healthy (N=14) had in place advance directives which dictated their end-of-life wishes. In contrast, participants who self-identified as fair or poor health (N=4) did not have advance directives (N=4). These "healthy" older adults also differed substantially from their counterparts in the degree in which they were socially engaged in their community and family, but varied little related to their actual medical diagnoses or health problems. The self-described healthy group approached advanced care planning as part of health promotion; they simultaneously planned for end-of-life while engaging in activities to maintain optimum health. In contrast, those who evaluated their health as fair or poor perceived advanced care planning as something to be avoided. Planning for end-of-life may be a form of ongoing engagement as it requires dialogue with health care providers, and thoughtful consideration of experiences and wishes. It may also be a manifestation of successful aging in that death is recognized as the culmination of a good life rather than something to be feared.