Planning for death but not serious future illness

Elderly people tend to be resistant to planning in advance for the hypothetical future, particularly for serious illness when death is possible but not certain. Planning in advance is widely encouraged as a way to improve quality of care at the end of life. Studies have shown that healthcare providers and patients often differ in their views on health related matters. The willingness to consider future illness and the end of life is not universal; patients in some communities are reluctant to consider or speak about such matters. Researchers at the Johns Hopkins Bayview Medical Centre Institutional Review Board, USA, interviewed 20 chronically ill housebound patients aged over 75 years to understand how elderly patients think about and approach future illness and the end of life. Sixteen people said that they did not think about the future or did not in general 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 is to 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, though 13 participants had made wills and 19 had funeral plans. Although some had completed advance directives, these were not well understood and were intended for use only when death was near and certain. Elderly housebound patients described a world view that does not easily accommodate advance care planning: they live life a day at a time, preferring not to consider problems until they occur. Physicians and patients should make plans in advance about possible future illness. The elderly people may be persuaded to participate in advance planning.