[What really matters can't be planned ahead : Impediments for advance care planning from a qualitative study on very old people living alone].

Background: Despite there is evidence for the need for advance care planning for older people living alone (OPLA), especially if they want to stay at home until the end, utilization of measures for ACP remains rather scarce. The causes for this discrepancy have not yet been researched in this target group.

Objectives: Aim of this study was to get insight into the perspectives of OPLA in the community on planning ahead for the end of life.

Materials and methods: (Secondary) Analysis of 26 qualitative interviews. 17 were from the Austrian Survey on the very old (ÖIHS), and 9 additional interviews were conducted with a specific focus on advance care planning to enrich the data base. Verbatim transcripts were analysed by applying coding procedures.

Results: Not all people had specific concerns or a desire to deal with the end of life. In contrast to others, concerns about avoiding (unnecessary) life-prolonging measures resulted in a formal regulation, usually a living will. Staying at home or issues regarding burial and inheritance were often equally important concerns for OPLA. Numerous obstacles to formal arrangements were identified.

Conclusion: The heterogeneity of OPLA with regard to their willingness and form of planning ahead for staying at home shows the limits of standardized procedures. Comprehensive approaches to advance care planning that go beyond health issues are needed to meet the concerns of OPLA in the community.