The stability of older adults' judgments of fates better and worse than death

Abstract

Decisions about specific life-sustaining medical treatments have been found to be only moderately stable over time. This study examined whether more general judgments, such as whether a particular health condition is better or worse than death, would exhibit greater stability. Fifty adults (aged 65 yrs and older) made judgments about the perceived quality of life (QOL) possible in a number of hypothetical states of impaired health and their desire to live or die (LOD) in each state. Judgments were made twice from 5 to 16 months apart (M = 10.7 mo). Both QOL and LOD judgments demonstrated only moderate stability regardless of the method of analysis used. Judgments about states characterized by severe impairment became more moderate over time with a substantial minority of participants viewing the states as worse than death at the initial interview viewing them as better than death at follow-up. Participants who did not have a living will, did not have children, had a lower perceived QOL at the follow-up interview, and had a longer time between interviews had more unstable judgments. The implications of these findings for the use of instructional advance directives are discussed.