Researchers in the United States interviewed 20 chronically ill housebound patients, aged over 75 years, about their views on advance planning of care.
Sixteen people said they did not think about the future or did not plan for the future. Nineteen were particularly reluctant to think about, discuss, or plan for serious future illness. Instead they described a "one day at a time," "what will be will be" approach to life, preferring to "cross that bridge" when they got to it.
Participants considered end of life matters to be in the hands of God, although 13 had made wills and 19 had funeral plans. Although some had completed living wills, these were not well understood and were intended for use only when death was near and certain.
"Our findings contrast with a central tenet of good care at the end of life: that physicians and patients should make plans in advance about possible future illness," say the authors. "The elderly people we interviewed described a world view that does not easily accommodate such advance planning."
Despite some limitations, this study shows that scrupulous attempts to plan about care in advance will not, in all cases, solve the problem of decision making for seriously ill and incapacitated patients, they conclude.