Almost a quarter of Americans over age 75 have not written down or talked to someone about their wishes for the end of life care, according to a new survey from Pew Research Group.

The survey, conducted with nearly 2,000 adults, also found that three out of 10 people who described their health as “fair” or “poor” also have not conveyed their wishes.

There has, however, been more than a doubling over the past 20 years in people who have put their end-of-life decisions into writing, Pew found. Today 35% of people report they have either put those wishes into an informal document, such as a letter, or a legal statement such as a healthcare directive. That’s up from 16% in 1990.

There also were differences correlated to race and religion.  White Protestants and white Catholics were more likely to say they would stop medical treatment if they had an incurable disease and were in pain when compared to black Protestants and Hispanic Catholics.

The full report, “To End Our Days: The Social, Legal and Political Dimensions of the End-of-Life Debate,” can be seen here.