Original ArticlesDecision Making Among Older Adults at the End of Life A Theoretical PerspectiveRomo, Rafael D. PhD, RN, PHN; Dawson-Rose, Carol S. PhD, RN, FAAN; Mayo, Ann M. DNSc, RN, FAAN; Wallhagen, Margaret I. PhD, GNP-BC, FGSA, AGSF, FAAN Author Information School of Nursing, University of California, San Francisco (Drs Romo, Dawson-Rose, and Wallhagen); and Hahn School of Nursing and Health Sciences and Beyster Institute for Nursing Research, University of San Diego, San Diego, California (Dr Mayo). Correspondence: Rafael D. Romo, PhD, RN, PHN, School of Nursing, University of Virginia, 225 Jeanette Lancaster Way, Charlottesville, VA 22903 ([email protected]). Preliminary findings were presented as a poster at the 2013 Annual Scientific Meeting of the Gerontological Society of America, New Orleans, Louisiana.Rafael D. Romo was supported by a John A. Hartford Foundation/Building Academic Geriatric Nursing Capacity predoctoral scholarship and a grant from the S. D. Bechtel Foundation Jr/UCSF Geriatrics Program for the Aging Century. The authors thank Tom Fairbanks for the graphic design. They extend a special thanks to Laura L. Ellingson, PhD, Santa Clara University, for her generous efforts reviewing and critiquing drafts of this manuscript.The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Advances in Nursing Science 39(4):p 308-319, October/December 2016. | DOI: 10.1097/ANS.0000000000000139 Buy Metrics Abstract Understanding changes in decision making among older adults across time is important for health care providers. We examined how older adults with a limited prognosis used their perception of prognosis and health in their decision-making processes and related these findings to prospect theory. The theme of decision making in the context of ambiguity emerged, reflecting how participants used both prognosis and health to value choices, a behavior not fully captured by prospect theory. We propose an extension of the theory that can be used to better visualize decision making at this unique time of life among older adults. © 2016 Wolters Kluwer Health, Inc. All rights reserved.