In 1900, the usual place of death was at home; in 2000, it was the hospital. In 1900, most people died in accidents or as a result of acute infections and they rarely endured long periods of disability. In 2000, people spent, on average, two years severely disabled on the way to death. Acute causes of death (such as pneumonia, influenza and septicemia) are in decline, whereas deaths from age-related, chronic, degenerative diseases (such as Alzheimer’s, Parkinson’s and emphysema) are on the rise.

A government study “The Dilemma of an Aging Society” tried to envision the future needs of elderly people who are terminally ill and classified the elderly into four groups:

The first group will die after a short period of sharp decline. This is the typical course of death from cancer. Roughly 20 percent of all deaths are of this type. This type of death peaks at the age of 65.
The second group will die following several years of increasing physical limitations, punctuated by intermittent acute life-threatening episodes. This is the typical course of death from chronic cardiac or respiratory failure. Roughly 20 percent of all deaths are of this type. Deaths from organ failure, generally heart or lung disease kill about 1 in four Americans around the age of 75.
The third-and the largest-group will only die after prolonged dwindling and frailty, usually lasting many years. This is the typical course of death from dementia (including Alzheimer’s disease) and disabling stroke. The trajectory towards death is gradual but unrelenting, with steady decline, enfeeblement and growing dependency, often lasting a decade or longer. Roughly 40 percent of all deaths are projected to be of this type. The older you are when you die, the more likely it is you will fall into this group.
The other 20 percent will die as a result of some sudden and acute event, like an accident.

These facts are astonishing. Eighty percent of us need to make planning for incapacity just as important as planning for death.

ADVANCE DIRECTIVES If your mental capacity becomes compromised as you age, or if you suffer an unexpected accident or illness, your spouse or your children may need to help manage your finances or your health care. Sounds simple? It’s not.

The fact is incapacity, like dying, is an event in your life where laws decide who has the authority to manage your affairs for you when you can’t. These are the laws your family and friends will be required to follow if you become unable to make decisions on your own behalf. When your children talk with your doctor, they will find the doctor requires a health care power of attorney signed by you giving one of your children the legal authority to make health care choices for you. Your spouse will discover he or she does not have the authority to sell a house you jointly own unless you have completed a durable power of attorney form appointing him or her as your attorney-in-fact.

The law recognizes the legal rights of a competent adult to leave instructions about what choices you want made regarding your health care and your finances and to appoint someone you trust to carry out those wishes. Each form serves a different purpose.

You can complete a Health Care Power of Attorney form appointing someone you trust to make health care choices for you.
You can complete a Living Will form documenting your end of life wishes.
You can complete a Durable Power of Attorney form giving someone you trust the power to act as your financial agent.

If you become physically incapacitated or are considered mentally incompetent, the law considers you unable to make decisions for yourself. If you have not completed forms appointing someone to make choices for you when you can’t, your family may need to involve the probate court to request and get authority to act on your behalf – for a fee.

If you have failed to write appropriate advance instructions or your instructions are incomplete, the court appointed agent will follow whatever instructions are provided for in your state laws.

For more information about the facts, forms and laws that manage your life in the event of incapacity or death, visit Get the knowledge you need to have an intelligent conversation with parents, children, lawyers and financial planners. Find resources and how to guides for taking care of aging parents and other end of life choices.

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