Knowledge, attitudes, and behavior of elderly persons regarding living wills

Although most states have enacted living will legislation, and many people have strong beliefs regarding medical intervention during terminal illness, only 15 percent of the people in a recent survey had actually signed a living will. Questions about end-of-life care too often arise after the patient is incapacitated, limiting patient autonomy. Such autonomy could be better assured if patients were counseled to make their wishes explicit beforehand. Little is known about how the elderly feel about living wills, and therefore this study of 75 elderly people was undertaken to study the knowledge, attitudes and behavior of the elderly concerning living wills. Most of these people wanted medical care limited during terminal illness, but none had signed a living will, even though just over half said they were familiar with state legislation. However, many had misconceptions about the law, which contained a great deal of technical language. When they were read the actual text, 60 percent said they were not aware they could sign such a document. The respondents did not fully understand such terms as ''extraordinary means'' and ''terminal and incurable,'' and these terms were not defined in the statute. Three out of four people surveyed wanted only basic medical care, such as antibiotics and intravenous fluids, during terminal illness, and 13 percent wanted comfort care only; however, 11 percent wanted all possible means of treatment. Physicians were not effective in pursuing this subject with patients, and only eight of the participants had discussed the topic with their doctors. Most felt that their physicians were unaware of their wishes. Educational efforts should be directed at elderly populations to explain the function of living wills. (Consumer Summary produced by Reliance Medical Information, Inc.)