National End-of-Life-Treatment Preferences are Stable Over Time: National Health and Aging Trends Study



      Advance Care Planning is a process of understanding and sharing preferences regarding future medical care.


      To explore individual and national stability of end-of-life treatment preferences among a sample of older adults.


      National Health and Aging Trends Study is a nationally representative sample of older adults. In 2012, a random sample, and in 2018, the entire sample were queried on end-of-life treatment preferences defined as acceptance or rejection of life prolonging treatment (LPT) if they had a serious illness and were at the end of their life and in severe pain or had severe disability. Using a cohort design, we explored individual trends in preferences for LPT among those with responses in both waves (pain scenario: N = 606, disability scenario: N = 628) and, using a serial cross-sectional design, national trends in LPT among the entire sample (1702 older adults in wave 2 and 4342 in wave 8).


      In the cohort study, individual preferences were stable over time (overall percent agreement = 86% for disability and 76% for pain scenarios), particularly for older adults who would reject LPT in wave 2 (overall agreement 92% for disability and 86% for pain). In the serial cross-sectional study, national trends in preferences for receipt of LPT were stable over time in the pain (27.4% vs. 27.0%, P = 0.80) and disability (15.8% vs. 15.7%, P = 0.99) scenarios.


      We found that national trends in preferences for end-of-life treatment did not substantially change over time and may be stable within individual older adults.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pain and Symptom Management
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sudore RL
        • Lum HD
        • You JJ
        • et al.
        Defining advance care planning for adults: a consensus definition from a multidisciplinary Delphi panel.
        J Pain Symptom Manage. 2017; 53 (e1): 821-832
        • Fried TR
        • O'Leary J
        • Van Ness P
        • Fraenkel L.
        Inconsistency over time in the preferences of older persons with advanced illness for life-sustaining treatment.
        J Am Geriatr Soc. 2007; 55: 1007-1014
        • Fried TR
        • Van Ness PH
        • Byers AL
        • et al.
        Changes in preferences for life-sustaining treatment among older persons with advanced illness.
        J Gen Intern Med. 2007; 22: 495-501
        • Fried TR
        • O'Leary JR
        Using the experiences of bereaved caregivers to inform patient- and caregiver-centered advance care planning.
        J Gen Intern Med. 2008; 23: 1602-1607
        • Kim YS
        • Escobar GJ
        • Halpern SD
        • et al.
        The natural history of changes in preferences for life-sustaining treatments and implications for inpatient mortality in younger and older hospitalized adults.
        J Am Geriatr Soc. 2016; 64: 981-989
        • Ditto PH
        • Jacobson JA
        • Smucker WD
        • Danks JH
        • Fagerlin A.
        Context changes choices: a prospective study of the effects of hospitalization on life-sustaining treatment preferences.
        Med Decis Making. 2006; 26: 313-322
        • Straton JB
        • Wang NY
        • Meoni LA
        • et al.
        Physical functioning, depression, and preferences for treatment at the end of life: the Johns Hopkins precursors study.
        J Am Geriatr Soc. 2004; 52: 577-582
        • Auriemma CL
        • Nguyen CA
        • Bronheim R
        • et al.
        Stability of end-of-life preferences: a systematic review of the evidence.
        JAMA Intern Med. 2014; 174: 1085-1092
        • Fried TR
        • Redding CA
        • Robbins ML
        • et al.
        Stages of change for the component behaviors of advance care planning.
        J Am Geriatr Soc. 2010; 58: 2329-2336
        • Auriemma CL
        • Nguyen CA
        • Bronheim R
        • et al.
        Stability of end-of-life preferences: a systematic review of the evidence.
        JAMA Intern Med. 2014; 174: 1085-1092
        • Frankford DM.
        The remarkable staying power of “death panels”.
        J Health Politics Policy Law. 2015; 40: 1087-1101
      1. Kaiser Health Policy Tracking Poll: December 2014. Available at: Accessed May 13, 2022.

        • Rainie L
        • Perrin A.
        Key findings about Americans’ declining trust in government and each other.
        Pew Res Cent. 2019;
      2. Hostetter M, Klein S. Understanding and ameliorating medical mistrust among Black Americans. the common wealth fund. Retrieved 2021;10:2021.

        • Harrison KL
        • Adrion ER
        • Ritchie CS
        • Sudore RL
        • Smith AK.
        Low completion and disparities in advance care planning activities among older Medicare beneficiaries.
        JAMA Intern Med. 2016; 176: 1872-1875
        • Morrison RS
        • Meier DE
        • Arnold RM.
        What’s wrong with advance care planning?.
        JAMA. 2021; 326: 1575-1576
      3. Stability of choices about life-sustaining treatments.
        Ann Intern Med. 1994; 120: 567-573
        • Gjerdingen DK
        • Neff JA
        • Wang M
        • Chaloner K.
        Older persons' opinions about life-sustaining procedures in the face of dementia.
        Arch Fam Med. 1999; 8: 421