Communication Between Older People and Their Health Care Agents: Results of an Intervention‪.‬

For older people, at a stage when death is a more immediate reality than at any other phase in the life cycle, the need for end-of-life planning is particularly compelling. Unfortunately, older people may not discuss end-of-life planning with people close to them, hoping that when death is imminent, their loved ones will know what to do (Sachs, Stocking, & Miles, 1992). When older people can speak for themselves, they can make their wishes about medical interventions known. However, when their ability to convey these wishes is compromised, significant others, faced with painful circumstances, may have nothing to guide them in dealing with medical decision making. There is general agreement that advance directives are valuable tools to help individuals communicate their wishes for future health care. In addition, there is agreement that it is preferable to execute these documents when individuals are healthy and able to approach the topic of end-of-life decision making with as little external stress as possible (Miles, Koepp, & Weber, 1996). Patients themselves indicate a preference for information about advance directives before the crisis of an acute illness (Nolan & Bruder, 1997; Schiff, Rajkumar, & Bulpitt, 2000).