Although advance directives for health care are widely advocated, usage rates among the elderly are low. Reported is a study testing comparative educational strategies to increase the use of advance directives among elderly persons ages 65 to 93. Follow-up interviews (n = 293) with intervention participants and controls showed that only 1 of 6 different strategies increased use. Neither lack of information nor simple procrastination were found as primary barriers to completion of advance directives. Most intervention participants preferred to defer to family surrogates and avoid executing advance directives. Level of education was a factor in use. Proposed is a restructuring of the advance directives process to accommodate elderly persons' wishes to authorize family members for surrogate health decision making, a policy that would assist the majority of people, including those who either wish to avoid or fail to execute advance directives.
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