As the elderly population continues to grow, this group will utilize a larger percentage of medical care than ever before. Accordingly, communication between health care providers and health care receivers needs to improve regarding end-of-life decisions. An important document associated with end of life decisions is an advanced directive (AD). ADs are methods of indicating an individual’s request (oral or written) regarding future medical care if a person is unable to communicate. The use of ADs in the population is rare; even though there is an interest in advance care planning by the general public and federal law promotes their use. There are many factors that influence the choices made at the end-of-life. They include ethical issues regarding quality of life, severity of illness/functional impairment, and resource allocation, lack of trust in the health care system, culture, and race of the patient and race of the physician, and setting. The literature indicates that the many factors that influence the decision to use advance directives needs to be further researched. This qualitative study examined and analyzed factors related to end-of-life decisions among older adults for the purpose of determining how to create more opportunities for older adults to learn about and complete ADs. Twenty conveniently sampled older adults above age sixty were interviewed using a structured guide as well as demographic and health status data were collected using self-administered questionnaires. Participants verbal responses were identified, coded, and categorized by the primary author. Themes were then analyzed for relevance to the research question and the study’s overall purpose. The demographic and health status data were summarized using SPSS version 9.0. Results revealed that there are many factors related to end-of-life decisions and care and the majority of the older adults had some knowledge of and experience with end-of-life decisions. Knowledge and experience with a relative or friend related to end of life care might be important factors in advance directive use. This suggests that health care workers interested in increasing the number of those signing advance care documents need to educate their patients regarding ADs. Increasing the number of those that sign advance care documents will require a serious commitment from many health care workers and organizations. Beginning with educational interventions that inform patients about ADs would be an excellent start.