Avoidant coping of the decision-making process on the location of care in old age: A possible conspiracy of silence?

The conspiracy of silence is extremely important due to both its high incidence and its consequences. This process usually occurs in situations of palliative care, or death; however, this concept is also mentioned in the literature linked to other contexts. Therefore, our objective was to study whether the conspiracy of silence may be extrapolated to the context of decision-making on the location of care in old age. To this end, we first analyzed the in-depth semi structured qualitative interviews conducted with older people, caregivers, and professionals, about decision-making on the location of care in old age. Subsequently, a comparative analysis was performed between the basic elements of the conspiracy of silence and this decision-making. Our findings revealed an avoidance process developed by all three groups. Furthermore, this decision-making presents similarities with the conspiracy of silence in the process of avoidance coping and denial that is developed. However, there are significant differences, as information is not withheld from the older person, who has an active attitude in the process of avoidance. Decision-making on the location of care in old age does not exactly match the conspiracy of silence process, but it does seem to correspond to a pact of silence.