Adults should begin discussing advance care planning well before a crisis — typically at legal adulthood and certainly whenever health changes. The Institute of Medicine Committee on Approaching Death, Institute of Medicine, recommended that conversations about goals of care become routine in clinical practice so preferences are known before incapacity. The National Institute on Aging supports discussing and documenting preferences early and updating them after major life or health events. These recommendations emphasize that planning is an ongoing process, not a one-time form.
Recommended timing
Start discussions at age 18 when a person can legally designate a health care proxy and complete advance directive documents, and bring the topic into primary care visits for adults with chronic conditions. Primary care clinicians and specialists should raise the topic at diagnosis of a serious or progressive illness, during hospital admissions, and after events such as stroke, new dementia diagnosis, or significant functional decline. Beginning while decision-making capacity is intact makes preferences clearer and reduces family burden later.
Relevance, causes, and consequences
Advance care planning matters because it shapes treatments during incapacity and aligns care with values. When clinicians routinely initiate conversations, research and policy reviews reported by the Institute of Medicine link higher rates of documented preferences, increased use of palliative care, and fewer unwanted invasive interventions at the end of life. Causes prompting earlier conversations include aging, multimorbidity, sudden hospitalization, and cognitive risk. Consequences of delayed planning can include family conflict, default aggressive care that may not match values, and missed opportunities for symptom-focused approaches.
Cultural and practical considerations
Conversations must respect cultural norms about family decision-making, religious beliefs, and territorial legal differences—states use different forms and processes for documents such as durable power of attorney or physician orders for life-sustaining treatment. Clinicians should use plain language, invite trusted family or community members, and document decisions in the medical record and with accessible legal forms. Routine framing as "planning for future care" rather than only end-of-life may increase acceptance across diverse communities.
Early, iterative discussion—initiated at adulthood, revisited with health changes, and led sensitively by trusted clinicians—produces clearer decisions, reduces stress for surrogates, and improves the likelihood that care will reflect the individual’s values.