Preferences for prolonging life: a prospect theory approach

Area of Science:

• Decision science
• Gerontology
• Health psychology

Background:

• Prospect theory offers a framework for understanding decision-making under uncertainty.
• Life-prolonging preferences are influenced by an individual's current health status and reference point.
• Understanding these preferences is crucial for advance care planning and healthcare decision-making.

Purpose of the Study:

• To test Prospect theory as a model for life-prolonging preferences in elderly individuals.
• To investigate how current health status (frail vs. healthy) affects preferences for future health states.
• To explore the malleability of life-prolonging preferences as health deteriorates.

Main Methods:

• A sample of 384 elderly individuals (263 healthy, 131 frail) from congregate housing participated.
• Participants indicated desired life duration across nine hypothetical health conditions.
• Analyses of covariance assessed preferences based on functional ability, cognitive impairment, pain, and current health status.

Main Results:

• A significant interaction was found between frailty and declining prospective health status.
• Frail participants expressed preferences for longer life in more compromised health conditions than healthy participants.
• These findings support Prospect theory's predictions regarding reference-dependent preferences.

Conclusions:

• Preferences for prolonging life are malleable and shift with deteriorating health.
• The study explains potential disparities between patient preferences and proxy decision-makers.
• Findings have implications for advance directives and patient-centered care.