Aging Options

One in Four Americans Avoids the Most Important Conversation of All

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Your loved ones may know how you want to live, but do they have a clue how you want to die someday? You may have a clear understand of how you wish to end your life when that time comes, but according to this recent article on the website HealthDay, more than one-quarter of American seniors have never discussed end of life care with those closest to them. In other words, one senior in four is avoiding the most important conversation any of us should be having!

This was the conclusion from a recent study of more than 2,100 Medicare recipients age 65 and older. Lead author Krista Harrison of the University of California, San Francisco, said that “Despite decades of work to improve advance care planning, over a quarter of older adults have still not engaged in any type of discussion or planning for their end-of-life preferences or plans.”  Here at AgingOptions, we find this statistic sadly predictable. As we always tell our clients, radio listeners and seminar attendees, letting your family members and your health care team know about your wishes is a critical step in retirement planning. If you fail to do so, you place great pressure on your loved ones who have to make decisions under extreme emotional stress without knowing what you would have wanted them to do in such difficult circumstances. You also place yourself in very real danger of having your wishes completely circumvented, perhaps with disastrous consequences. Nevertheless, people avoid the topic.

(We discovered other data that showed even greater levels of avoidance of the subject of end of life wishes. One study said that, while 90% of people agree that this subject is important to discuss among loved ones, barely one quarter have actually done so. What’s worse, said another, while 80% want their doctors to know their end of life wishes in the face of terminal illness, fewer than one in ten have actually had this conversation with their health care team.)

This article about people’s reluctance to discuss their end of life wishes made us wonder how the medical profession views this subject. We found many answers in this highly interesting and relevant article on the website Today’s Geriatric Medicine. While describing the need to talk with patients about end of life care as “critical,” the article revealed how few physicians are actually having this essential conversation with their patients. In spite of national guidelines that urge physicians to conduct regular conversations about end-of-life care planning with seniors and with terminally ill patients, “research suggests that physicians often avoid the subject with patients.” The article cites a 2014 study which found that “only 12% of health care providers reported having end-of-life care conversations with heart failure patients at routine annual visits.” The same is true for cancer patients: the majority of doctors “put off discussion of end-of-life care preferences with terminally ill patients as long as the patients were feeling well.” Instead these physicians tend to wait “until patients became symptomatic or until treatment options were exhausted.” This does a “disservice” to patients and their families.

This paragraph from the Geriatric Medicine web article couldn’t be clearer.  “If patients don’t establish their care preferences and communicate them to health care providers, the default is that patients will receive every available medical intervention as they approach death. This includes interventions that are burdensome to the patient, some of which have a very small chance of making a meaningful difference in the patient’s health. Many patients don’t actually want all such interventions.” The conclusion: “To ensure that a patient’s treatment is consistent with his or her goals for care, it’s critical for physicians to communicate in advance with patients about their care preferences.” The web article strongly suggests these conversations take place months, even years in advance, not when patients “are on the brink of death.” We heartily endorse this idea and believe families should also be more open, honest and proactive about discussing Mom and Dad’s desires concerning end-of-life issues.

Finally, one more note on this topic: the Geriatric Medicine article included a link to a website called The Conversation Project. Its entire purpose is to get people talking about their wishes for end of life care.  The website includes a step-by-step guide to discussing this important yet sensitive topic, an approach you might find helpful. Here at AgingOptions we can also assist in planning a family conference during which the full range of age-related topics is addressed.

So much for planning how to die. What about planning how to live? When it comes to enjoying the retirement you’ve dreamed of, we at AgingOptions are ready to be your guide with a planning process we call LifePlanning. Your LifePlan encompasses medical needs, financial strategies, housing preferences, legal protection and family communication, all in one carefully planned and comprehensive document. Don’t face your retirement years unprepared! Instead, why not take the next step and attend an upcoming LifePlanning Seminar near you? There’s no cost or obligation. In just a few brief hours you’ll gain valuable insight that will help you understand how powerful the LifePlanning concept can be for your future security and enjoyment. For information and online registration click on the Upcoming Events tab, or call us at AgingOptions. We’ll look forward to meeting you soon.

(originally reported at

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