Recently, researchers compiled results from over 150 studies from 2011 to 2016 looking at how many individuals had some kind of advance directive specifying life-sustaining care. Of nearly 800,000 people who were part of the studies, only 36.7 percent had some document discussing what medical care they would want if unable to make their own decisions.

It’s true that people older than 65 were significantly more likely to complete any type of advance directive than younger ones (45.6 percent vs. 31.6 percent). However, surprisingly there wasn’t a big difference between people who were healthy and those who were sick (32.7 percent compared with 38.2 percent).

Considering the aging population and attention surrounding end of life issues, why aren’t more people making plans for their care even when they have a chronic illness?

Unfortunately, many people are uncomfortable thinking about their own mortality. Some experts also believe individuals are concerned that if they specify that they don’t want a certain kind of treatment, then they won’t get appropriate care. In addition, people’s wishes and medical technology may change. For example, sometimes as patients age and develop medical problems they’re more willing to undergo treatments they might have rejected when they were younger and healthier. If they put their wishes into an advance directive, they may fear they are stuck with their choices.

Whatever the source of the fear, when individuals don’t take control of their health decisions and end of life care, others will make those decisions for them. That means people may be subject to care they would not want. In addition, they are putting an added burden on their loved ones to deal with these issues, which not only is emotionally difficult, but can lead to family and legal disputes when loved ones don’t agree with each other or doctors.

Everyone should have basic documents providing for what happens in the event they are not capable of making health or financial decisions. A Durable Power of Attorney, Health Care Proxy, Living Will and a Revocable or Irrevocable trust if needed ensures that your wishes will be followed. These documents should also be periodically reviewed in case you do change your mind about something.

The most important point is to start having conversations with your loved ones, doctor and legal advisor so you understand the choices you are making and you feel comfortable your wishes will be honored.

For more information on end-of-life planning, read our related posts: Taking Control of End of Life Decisions and Become a Pro-Choice Senior.