Late-Life Decision-Making

Abstract

People aged 85 and above are the fastest growing population segment worldwide, yet academic research on this life stage tends to focus on caregiving, ill health, disability, and dementia. In contrast, this thesis examines community-dwelling older people who are in relatively good health and living independently in a suburban borough of London. The research seeks to understand how people aged 85 and above think about and make decisions. The study examines how decision-making has changed throughout the lifecourse, what specific future decisions are anticipated and what heterogeneity exists in late-life decision-making. Using qualitative longitudinal research, 17 community-dwelling people aged 85 and above were interviewed on four occasions. Analysis used a case study approach, where each participant was a case.

Results suggest that the main goal of late-life is to continue living as fully as possible and doing activities that give life meaning. In the process, financial and social resources are deployed strategically to counter possible health decrements. Regarding decision domains, this research proposes that there are only four main decision domains throughout the lifecourse: 1) the activities of life; 2) the people and relationships that enliven them; 3) the resources that support them, and 4) identity. In earlier life, decisions are made about building resources, developing an understanding of the activities that give life meaning, and deciding on values and ethos. In laterlife the focus shifts to strategically deploying resources to support continuing engagement and to protect identity. A lifetime of experience informs these decisions, but in later-life two specific emotions motivate decisions: ‘want’ in how much something is desired, and ‘fear’ in anticipation of possible adverse consequences.

The principal decisions of very-late-life concern death and end-of-life. To the participants, decisions about death concern administrative matters. End-of-life, however, is considered as a time when they are no longer able to live their lives fully and need to contemplate possible care.

The process for making this decision changes because of the need to balance the goal of maintaining independence with the recognition that they may need to redefine identity, to becoming someone who needs care. In considering possible care, information will be gathered, friends consulted, strategies developed, and interim interventions employed. The final decision, for a care home or full-time care, will be deferred, waiting for a precipitating event which forces the decision. There appears to be a gender difference in decision-making in that women are more proactive about implementing interventions and continuing to build and develop social networks which can also be called upon for assistance.

This research contributes to the limited literature regarding the decision-making of community-dwelling people aged 85 and above. It will increase understanding of late-life and will counter the perception of late-life as a time of depredation to show older people as agentic and able to maintain decision control into very-late-life.

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Identifiers

ORCID for Heather Mulkey: orcid.org/0000-0002-0108-7713

ORCID for Elisabeth Schroeder-Butterfill: orcid.org/0000-0002-5071-8710

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