A comprehensive advance care planning program successfully increased documentation rates of patient preferences by 23% but paradoxically led to more intensive medical interventions during final months of life. The structured intervention, which included patient-provider discussions and formal documentation protocols, resulted in higher rates of ICU admissions, mechanical ventilation, and aggressive treatments among participants compared to standard care groups. This counterintuitive finding challenges the assumption that better communication automatically translates to less aggressive end-of-life care. The results suggest that simply having advance directives may not be sufficient—the quality of conversations and how preferences are interpreted by medical teams appears equally critical. For aging adults, this highlights a gap between stated preferences for comfort-focused care and actual clinical implementation. The study reinforces emerging evidence that advance care planning requires ongoing refinement beyond documentation alone. Healthcare systems may need to emphasize not just capturing preferences but ensuring those preferences are accurately understood and consistently honored across care transitions. This represents a significant opportunity to improve both patient autonomy and resource allocation in geriatric medicine.