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Planning for death but not serious future illness: qualitative study of housebound elderly patients
Joseph A Carrese1, Jamie L Mullaney, Ruth R Faden
1Phoebe R Berman Bioethics Institute, Johns Hopkins University, and Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA. jcarrese@JHMI.edu
Objective:
To understand how elderly patients think about and approach future illness and the end of life.
Design:
Qualitative study conducted 1997-9.
Setting:
Physician housecall programme affiliated to US university.
Participants:
20 chronically ill housebound patients aged over 75 years who could participate in an interview. Participants identified through purposive and random sampling.
Main Outcome Measures:
In-depth semistructured interviews lasting one to two hours.
Results:
Sixteen people said that they did not think about the future or did not in general plan for the future. Nineteen were particularly reluctant to think about, discuss, or plan for serious future illness. Instead they described a "one day at a time," "what is to be will be" approach to life, preferring to "cross that bridge" when they got to it. Participants considered end of life matters to be in the hands of God, though 13 participants had made wills and 19 had funeral plans. Although some had completed advance directives, these were not well understood and were intended for use only when death was near and certain.
Conclusions:
The elderly people interviewed for this study were resistant to planning in advance for the hypothetical future, particularly for serious illness when death is possible but not certain.