In the early months of the pandemic, especially when it became clear that older adults were at high risk of serious illness or even death from COVID, there was the hope that advance care planning (documenting your wishes regarding end-of-life care and appointing a health care proxy to speak on your behalf if you became unable) would become important to individuals and their loved ones. Given the dramatic use of ventilators and the high risk of death so many older people faced, it seemed to be the ideal time to begin to consider our preferences and values when it comes to end-of-life treatments and decision-making. Articles were published and even our own creator of the Powerhouse Patient blog posts, Julie Buyon, advised planning in advance given the unexpected nature of the pandemic. 

But in the months that have followed, it seems the results are mixed- at best- regarding a more widespread embrace of living wills and health care proxies among older adults and their families. According to a new study from the National Poll on Healthy Aging out of the University of Michigan, while 70% of those polled over 65 said they had had a conversation with loved ones about end-of-life care, less than half said they had actually completed either a health care proxy/power of attorney form or a living will to document their wishes. In fact, only 7% of respondents said the pandemic had motivated them to take action. What reasons did they give for not documenting their wishes? The majority claimed they had just not gotten around to it, while much smaller percentages cited discomfort talking about the end of life, thinking such documents are unnecessary, or no one asked them to consider such documents. 

To underscore this resistance, a new article published in Health Affairs looked at the level of advance care planning following the 2016 Medicare policy to reimburse primary care physicians for such discussions during the annual Medicare wellness visit. Despite an uptick in claims for these conversations, the reality is that few patients seemed to have been counseled to create advance care plans toward the end of their lives. Why is this? Doctors claim a lack of training as well as the reality that many of these sorts of conversations occur with lawyers developing estate plans rather than with doctors who may be closer to the actual decision-making need. Of course, if doctors are not holding these conversations with their patients, and instead they are left to the estate planning realm, those in lower socio-economic circumstances are less likely to be given the opportunity to then make their wishes and preferences clear- which is exactly what a recent article in Scientific American found.

But there is reason for optimism and the opportunity to have these conversations and to document your wishes. A recent study published in JAMA out of the Southern California Kaiser System found that among older patients who died, 80-90% had discussed their wishes with next of kin, had received care and treatment that met their wishes, and thought their end of life care was appropriate (according to a survey of next of kin). Given that there is often a disconnect between the care patients want and the care they receive at the end of life, this reflects how important these conversations are for patients and their loved ones. And given that tomorrow, April 16th, is National Healthcare Decisions Day, we want to urge and remind you to take the time to discuss your wishes and document your preferences, for yourself and your loved ones, who may need to make decisions for you. For some helpful guidance on how to take the plunge and document your wishes, first take a look at this AARP resource connecting you to your own state’s advance directive forms. You may also want to check out the websites from some of the leading organizations available to help you initiate and document such a conversation. So take out your pen and pad, and look here and here. Finally, if you already have such a document, make sure it still represents your wishes and preferences. Recent research suggests that may not be the case for everyone and it’s always best to remember end-of-life discussions should be ongoing rather than static. For yourself and your loved ones, keep talking and keep updating.