Exploring Health Care Decison-Making of Older Adults: Consistency and Clarification of Responses Over Time

This study investigated the stability of health care decisions and the influencing values of 21 competent older adults. Face to face interviews were conducted initially (T1) followed by taped, telephone interviews seven years later (T2). Each participant was presented with a list of value indicators from which they were asked to identify the five most influential values to their health care decision-making process. They were also instructed to make decisions regarding five health care treatment and five life-sustaining treatment scenarios across two health states and three different levels of prognosis. Using open ended questions, participants described why they would or would not consent to medical or life-sustaining treatments. No significant change in healthcare decisions was found for life-sustaining treatments over the seven year period. The only significant change for health care treatments was an increase in the proportion of individuals "not consenting" to hip replacement surgery from T1 to T2 regardless of health state or prognosis. Similarly, change occurred between T1 and T2 with more participants refusing cataract surgery with a prognosis of 50/50. High stability was noted with the values selected by participants. Four out of the top five values selected at the initial interview were also selected seven years later. Data from the interview transcripts revealed congruence between the values chosen on the values inventory and those described as factors determining whether or not consent was given to the medical or life-sustaining treatments at T1 and T2.