Perceptions of age and aging in the context of medical decision-making. A qualitative, case-vignette-based focus group study with physicians, nursing staff and seniors

Background: While interactions between the perception of one's own age and different parameters of health and health behavior are well-researched, only few publications focus on perceptions of old age in the context of medical decision-making. Therefore, we examined how old age is perceived by physicians, nursing staff, and people aged 75 or older in the context of medical decision-making. Methods: The study employed a qualitative research design, conducting 16 focus group discussions (N = 79): five with physicians (n = 24), five with nursing staff (n = 28), and six with people aged 75 and older (n = 27). Discussions were initiated by two case vignettes stating geriatric decision-making situations. To include the perspectives of people unable to attend group discussions, eight individuals aged 75 or older were interviewed individually. Qualitative content analysis was used to analyze the data. Results: Four major dimensions of old age were derived from the data: (1) age means freedom and autonomy, (2) age means (risk of) decline, (3) age brings age-related tasks, (4) age means being closer to death. They interrelate and lead to a shift in wishes, perspectives, preferences, and priorities regarding medical treatment. Conclusion: The four identified dimensions coexist and may contradict one another. Perceptions of age and aging, both among older adults and healthcare professionals, can influence medical decision-making by shaping how priorities and preferences evolve with increasing age. These findings highlight the importance of explicitly exploring and understanding individual patients’ wishes and values, particularly in advanced age, to ensure that medical decisions align with personal perspectives and needs.