Beyond the Individual: The Interdependence of Advance Directive Completion by Older Married Adults

Abstract

OBJECTIVES:To determine how individual and spousal demographic and health factors are associated with advance directive (AD) completion by married older adults. DESIGN: Dyadic structural equation modeling using the Actor-Partner Interdependence Model. SETTING: The 2004 to 2012 waves of the Health and Retirement Study. PARTICIPANTS: Community-dwelling heterosexual married couples aged 65 and older (N = 2,243). MEASUREMENTS: Structural equation modeling with a probit link function was used to estimate associations between men's and women's age, education, health status, prior hospitalization or outpatient surgery in the past 10 years, regular health care provider, and household net assets and their own and their spouses' probabilities of having an AD. RESULTS: Individual and spousal ages were each positively associated with AD completion for men and women. Those with higher education were more likely to possess ADs. Women's probabilities of having ADs were also positively associated with husbands' education. Men whose wives' were in poor health were less likely to have ADs. Men who were hospitalized or underwent outpatient surgery were more likely to have ADs, as were their wives. Women who had regular sources of health care were more likely to have completed ADs. CONCLUSION: AD completion by older married adults is associated with both individual and spousal factors. How spouses influence one another's advance care planning differs by gender. Future research should account for the dyadic nature of advance care planning, as should public education efforts and interventions promoting AD completion.

Are older adults’ demographic characteristics social determinants of their perceived importance, desire, and ability to perform end‐of‐life self‐care actions?

“…Older adults who are single also were more likely than their married counterparts to indicate they were able to update and share their living will each year. Although this finding is counterintuitive and does not agree with the results of some other studies, it is possible that single older adults are more inclined to create an EOL life plan because they have to rely on themselves for planning for their future. Additional research is warranted to confirm this relationship.…”

“…Although this finding is counterintuitive T A B L E 3 Summary of the multiple logistic regression analyses with the perceived importance of four older adult engagement self-care actions for planning for the End-of-Life and the desire and ability of older adults to perform these actions. and does not agree with the results of some other studies, 19,24,27 it is possible that single older adults are more inclined to create an EOL life plan because they have to rely on themselves for planning for their future. Additional research is warranted to confirm this relationship.…”

“…Kossman 14 examined racial differences in advance directive completion between white and African American older adults and found that white women who were advanced in age and had a higher level of education were more likely to have a living will be compared with their African American counterparts. Koss 24 found that older adults who were married were more likely to complete EOL planning. were used as the theoretical frameworks guiding this study.…”

‘Til Death Do Us Part: End‐of‐Life Experiences of Married Couples in a Nationally Representative Survey

“…As hypothesized, when the first spouse used hospice or had no ACP, the second spouse was more likely to engage in hospice or have no ACP. Results contribute to literature showing that married couples act similarly on a range of health behaviors, [11][12][13][14] and literature showing that spouses are more likely to have ACP if their partner has engaged in ACP 9,30 or their partner has died. [31][32][33][34][35] We expand on our understanding of spousal concordance related to ACP and hospice use through 2 additional findings.…”

Predictors of Advance Care Planning in Older Women: The Nurses’ Health Study

“…Overall, interestingly, we found that our findings in community-dwelling nurses regarding predictors of ACP were quite similar to findings previously reported among institutionalized patients and patients at the EOL [30][31][32][33][34][35][36] (such as African American race, illness, a recent experience of death in close friends or family, and greater social support). [7][8][9]11,18,19,25,[37][38][39][40][41][42] Among these former nurses, although the prevalence for ACP documentation was high at 84%, the prevalence for recent ACP discussions with physicians was much lower at 35%. Yet the evidence is increasingly clear that efforts to facilitate patient-centered EOL care should focus on encouraging ongoing patient-clinician ACP discussions.…”