The aim of this study was to explore older people’s wishes concerning their length of life, self-perceptions of their health, wellbeing and functioning, and lastly whether their documented living wills (LWs) are associated with care at the end of life. The study was based on random samples of 75–96-year-old community-dwelling people in Helsinki (HEVA [the Helsinki Aging Study 1989, 1999 and 2009] and DEBATE [Drugs and Evidence-BAsed medicine in The Elderly 2000–2010]). In the DEBATE study the association between baseline will-to-live (WTL) and survival in the next ten years was analysed in a follow-up study of 283 participants (Study I). A wish to live up to 100 years, with reasons for this wish was explored in a cross-sectional study (Study II) concerning 1405 participants in the HEVA 2009 study. Changes in self-rated health (SRH), psychological wellbeing (PWB) and disability were rated, comparing cohorts in 1989, 1999 and 2009 (Study III, with 4898 participants). The association between baseline LWs and end-of-life care of 207 deceased DEBATE participants with cardiovascular disease (Study IV) was evaluated in a ten-year follow-up study. A long WTL was more common in males, in younger people, and in those with good SRH. In a ten-year follow-up study, baseline WTL was a strong predictor of survival irrespective of age, gender and comorbidities (Study I). In Study II, 33% of the respondents were willing to become centenarians, some of them conditionally if functioning remained sufficient. A wish not to live extremely long was associated with fear of the future, negative attitudes and anticipation of diseases or disabilities. When comparing age cohorts over 20 years (Study III), SRH and PWB improved from 1989 to 2009, but levelling-off of previously detected improvements in physical functioning were worrisome. Living wills (Study IV) did not seem to affect the intensity of received care at the close of life. However, death occurred more often at home among those who had completed a LW at baseline, compared with those without a prior LW (17% vs. 6%). Even though self-perceptions have been regarded as increasingly important, studies on WTL among older people have been scarce. Treatment options and specific health conditions were not in the scope of the present study, but instead, the results emphasize the importance of listening to older people themselves when planning their treatment plans and when developing future preventive and rehabilitative measures to support their WTL, quality of life, and functioning. The results of the present work suggest that increasing psychological wellbeing and care more congruent with patient preferences is possible. However, levelling-off of improving physical functioning among older people and the oldest-old is a study result that may demand more resources in social and health services than previously predicted. Discussions about preferences, living wills and their documentation in health files is suggested to take place early in primary care, even before severe diseases or disabilities.
|Status||Publicerad - 2019|
|MoE-publikationstyp||G5 Doktorsavhandling (artikel)|
- 3142 Folkhälsovetenskap, miljö och arbetshälsa