Older adults have long been encouraged to maintain their autonomy by expressing their wishes for health care before they become too ill to meaningfully participate in decision making. This study explored the manner in which community-dwelling adults aged 55 and older plan for serious illness. An online survey was conducted within the province of Saskatchewan, Canada, with 283 adults ranging in age from 55 to 88 years. Planning for future medical care was important for the majority (78.4%) of respondents, although only 25.4% possessed a written advance care plan and 41.5% had designated a substitute decision maker. Sixty percent of respondents reported conversations about their treatment wishes; nearly half had discussed unacceptable states of health. Associations between key predictor variables and planning behaviors (discussions about treatment wishes or unacceptable states of health; designation of a substitute decision maker; preparation of a written advance care plan) were assessed using binary logistic regression. After controlling for all predictor variables, self-reported knowledge about advance care planning was the key variable significantly associated with all four planning behaviors. The efforts of nurses to educate older adults regarding the process of advance care planning can play an important role in enhancing autonomy. 1. Introduction Given that almost three quarters of older adults lack decision-making capacity when urgent choices about life-sustaining treatment need to be made [1], older adults have long been encouraged by nurses and other health care providers to express their wishes for health care while they are healthy enough to meaningfully participate in treatment decision-making. Advance care planning has been recently promoted by the Centers for Disease Control and Prevention [2] as a process contributing to overall public health through its focus on supporting the individuals’ health care choices and preventing unnecessary suffering. Widespread social marketing of advance care planning has made many excellent online and print resources available to the public [2–4]. Although advance care planning is now seen as an iterative process that includes the way in which people think about and communicate their values and preferences so that they may receive the health care they desire in the case of life-threatening illness [5], much of the extant research in this area has focused upon the completion of written advance care plans. Using a population-based approach, this study addressed the research question “How do community-dwelling
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