Differences in the execution/nonexecution of advance directives by community dwelling adults

Factors associated with the process of execution or nonexecution of advance directives, that is, living wills and/or durable powers of attorney for health care, by community dwelling adults are described. Data were collected by mail (n = 210, 51% response rate); 18.1% (n = 38) had executed an advance directive (AD). Significant differences were noted between AD executors and nonexecutors. Executors were older than nonexecutors. Executors had greater concern about an executed AD diminishing the quality of care they received. They participated in more MD-initiated discussions about ADs, and had more numerous AD educational experiences, more personal experience with the terminal illnesses or critical injuries of relatives or friends, a greater degree of familiarity with AD documents, and a greater degree of religiosity. The integration of these factors at various points along a continuum of intentional self-change moves an individual through several stages of a behavioral change process, culminating with the execution or nonexecution of an AD.