Abstract
Background/Objectives
Advance directives (ADs) help align end-of-life care with individuals’ preferences, reduce unwanted interventions, and support coordinated care. Yet completion rates remain low despite attention from policymakers and healthcare systems. Understanding what triggers individuals to formalize their preferences is key to improving advance care planning strategies. This study explores self-reported reasons for AD completion among older adults in Switzerland.
Methods
We conducted a cross-sectional descriptive analysis using the Swiss sample the Survey of Health, Ageing and Retirement in Europe (SHARE) Wave 10 (2024/2025). The study included respondents aged 50+ who reported having completed an AD (N = 983). Reasons were assessed using a multiple-response question. We report unweighted proportions, calculated as the mean of binary indicators for each response. As multiple responses were allowed, proportions do not sum to 100%.
Results
The most cited reason on average was having learned about ADs (25.8%), followed by personal reflection (13.6%), feeling older (10.4%), advice from relatives or friends (10.2%), and completing a testament or power of attorney (9.9%). Health-related triggers were less common, including deterioration in a relative’s health (6.9%) and one’s own health (3.4%), while hospitalization (2.3%) and nursing home entry (0.4%) were rare. Healthcare provider advice was cited by 5.0% and insurance advice by 0.6%. COVID-19 was mentioned by 3.3%, while 6.3% reported no specific trigger.
Conclusions
AD completion appears to be driven more by awareness and individual reflection than by acute health events or clinical encounters. Promoting advance care planning may therefore require broader public health approaches beyond healthcare settings, including key life-planning moments. Improving awareness and facilitating early engagement, may increase uptake and support more timely and informed end-of-life planning.
Key messages
• Advance directive completion is driven more by awareness and personal reflection than by acute health events or clinical encounters.
• Promoting advance care planning beyond healthcare settings, including key life-planning moments, may increase uptake of advance directives.