Death, denial, and defeat: older patients and advance directives.

This article describes a phenomenological study involving 17 older persons who shared their reasons for not having formalized their end-of-life decisions. The study found they vacillated between fear and acceptance of death, trust and mistrust that others would or would not act according to their wishes, the assumption of immortality or the inevitability of death, and the denial or lack of knowledge of the necessity for legalizing their wishes. A discussion of the implications of these findings for nurse practitioners is presented.