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Seniors Can Take the Guesswork Out of End-of-Life Issues

Talking about end-of-life issues can be a tricky subject.

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One in Four Lacks the Ability to Make Decisions

It’s a subject that families often try to avoid -- end-of-life issues. If it’s a touchy topic for your family, seek out the resources to help make the conversation easier.

Q.My 82-year-old mother refuses to address her end-of-life wishes. I don’t like to think about her passing either, but I’d much rather know what she would want. Do you have any suggestions? I’m afraid she will get to the point where she will be unable to make these decisions for herself.

Your concerns are certainly warranted. More than one in four elderly Americans lacks the capacity to make their own medical care decisions at the end of life, according to a study of 3,746 people that was published in the New England Journal of Medicine.

Those who had advance directives including living wills or durable powers of attorney for healthcare received the care they wanted most of the time, says lead author Maria Silveira, M.D., M.P.H., physician scientist at the VA Ann Arbor Healthcare System’s Clinical Management Research and assistant professor of Internal Medicine at the University of Michigan.

“Our research shows that a substantial number of older adults need someone else to make decisions about whether aggressive, limited or comfort care should be provided at the end of life,” Silveira said. “This study underscores the need to prepare oneself and one’s family for the often emotional and difficult medical decisions that can arise at the end of life. It also suggests that the time spent to craft a living will and appoint a durable power of attorney for health care can be worthwhile.”

Advance directives usually document patients’ wishes for life-sustaining treatment in a living will, as well as their choice of a proxy decision-maker in a durable power of attorney for health care.

Many people do not understand that advance directives are used only when patients can’t make medical care decisions for themselves, and they can be revoked by the patient at any time, either in writing or orally, Silveira said. Advance directives are frequently confused with wills and durable powers of attorney, which have no bearing on medical care decisions.

You can help your senior loved one take some of the guesswork out of this process. If you need help talking to your mother about end-of-life issues or for more information about resources, read more on Life Legacies. You’ll find tips about how to discuss sensitive topics like these.

For more about the research, log on to

Last revised: July 5, 2011

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