What Triggers Advance Directive Completion? Population-Level Evidence from Adults 50+
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.
Related
- Factors associated with advance directive completion among older adults with and without cognitive impairment: a nationwide cross-sectional study
- Proactive Opportunities for Advance Care Planning (PRO-ACP): improving advance care planning completion among hospitalised internal medicine patients with life-limiting illness.
- Negative Word Production in Bilinguals Triggers Inhibitory Mechanisms: Evidence from Mass Univariate Time-Frequency Analysis
- The Lipid Paradox in Chronic Liver Disease: Integrative Evidence From Intrahepatic Transcriptomics and Population-based Cohorts
- LDLR -3′UTR Deletions Identified as a Genetic Cause of Hypobetalipoproteinemia: Evidence From Familial and Population-Based Studies
BibTeX
@article{pigazzini2026what,
title = {{What Triggers Advance Directive Completion? Population-Level Evidence from Adults 50+}},
author = {GP Pigazzini and CM Meier and PS Sillitti and RJJ Jox and JM Maurer},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1846},
url = {https://doi.org/10.1093/eurpub/ckag169.1846},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - What Triggers Advance Directive Completion? Population-Level Evidence from Adults 50+
AU - GP Pigazzini
AU - CM Meier
AU - PS Sillitti
AU - RJJ Jox
AU - JM Maurer
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1846
UR - https://doi.org/10.1093/eurpub/ckag169.1846
AB - 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.
SN - 1101-1262
SN - 1464-360X
ER -