Exploring Older Adults’ Preferences for Future Healthcare and Financial Decisions Through Anticipatory Legal Instruments: Findings from a Dutch Survey

Anticipatory legal instruments are internationally promoted as tools to safeguard autonomy in future healthcare and financial decision-making, yet empirical research has largely concentrated on medical contexts. This study broadens the scope by examining documentation practices among older adults in the Netherlands across both domains. Using a mixed-methods design, we analysed quantitative and qualitative data from a nationwide survey (N = 1,634) to identify characteristics associated with formal documentation and explore motivations for engagement or non-engagement. Logistic regression analyses showed that older age and higher educational attainment consistently increased the odds of documentation. Having a close family network was positively associated with documenting preferences as well, particularly in financial matters. Conversely, a first-generation migration background significantly reduced the odds of financial documentation, while the presence of psychiatric conditions was negatively associated with healthcare documentation. Qualitative findings revealed diverse motivations for documenting preferences, such as maintaining control, reducing burden on loved ones, and ensuring clarity. Reasons for non-engagement included emotional discomfort, procrastination, trusting family members to make the right decisions, and financial constraints. Combined, these findings show that anticipatory planning is not merely a legal exercise but, in fact, a deeply personal process shaped by demographic, social and health-related factors, as well as personal motivations and perceived barriers. Policy efforts should prioritise accessible, inclusive and tailored strategies that normalise proactive planning as part of healthy ageing.