We examined the formal and informal advance care planning (ACP) patterns of older couples and determined how these patterns are associated with individual and spousal characteristics.
Methods
Using data from the 2014 and 2016 Health and Retirement Study, we performed latent class analysis to identify ACP patterns and multinomial regression models to describe characteristics of older couples (N = 2195 couples).
Results
We identified four ACP patterns: high engaging couple (47%); high engaging husband—low engaging wife (11%); high engaging wife—low engaging husband (11%); and low engaging couple (31%). High engaging couples were more likely to be older, educated, and financially better off, whereas high ACP engagement in discordant ACP patterns was associated with health and wives’ constraints.
Discussion
A couple-based approach was recommended to promote the merits of ACP where spouses were older, had limited resources, or where one or both partners were suffering from poor health.
BerkmanL. F.GlassT.BrissetteI.SeemanT. E. (2000). From social integration to health: Durkheim in the new millennium. Social Science & Medicine, 51(6), 843–857. https//doi.org/10.1016/s0277-9536(00)00065-4
2.
BischoffK. E.SudoreR.MiaoY.BoscardinW. J.SmithA. K. (2013). Advance care planning and the quality of end-of-life care in older adults. Journal of the American Geriatrics Society, 61(2), 209–214. https//doi.org/10.1111/jgs.12105
3.
BoernerK.CarrD.MoormanS. (2013). Family relationships and advance care planning: Do supportive and critical relations encourage or hinder planning?The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 68, 246–256. https//doi.org/10.1093/geronb/gbs161
4.
BoernerK.MoormanS. M.CarrD.OrnsteinK. A. (2021). Insufficient Advance Care Planning? Correlates of Planning Without Personal Conversations. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 76(1), 104–108. https//doi.org/10.1093/geronb/gbaa076
5.
Brinkman-StoppelenburgA.RietjensJ. A.van der HeideA. (2014). The effects of advance care planning on end-of-life care: A systematic review. Palliative Medicine, 28(8), 1000–1025. https//doi.org/10.1177/0269216314526272
6.
CarrD. (2012). The social stratification of older adults’ preparations for end-of-life health care. Journal of Health and Social Behavior, 53(3), 297–312. https//doi.org/10.1177/0022146512455427
7.
CarrD.LuthE. A. (2017). Advance care planning: Contemporary issues and future directions. Innovation in Aging, 1(1), igx012. https//doi.org/10.1093/geroni/igx012
8.
CarrD.MoormanS. M.BoernerK. (2013). End-of-life planning in a family context: Does relationship quality affect whether (and with whom) older adults plan?The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 68(4), 586–592. https//doi.org/10.1093/geronb/gbt034
DreweliesJ.ChopikW. J.HoppmannC. A.SmithJ.GerstorfD. (2018). Linked lives: Dyadic associations of mastery beliefs with health (behavior) and health (behavior) change among older partners. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 73(5), 787–798. https//doi.org/10.1093/geronb/gbw058
11.
ElderG. H (1994). Time, human agency, and social change: Perspectives on the life course. Social Psychology Quarterly, 57(1), 4–15. https//doi.org/10.2307/2786971
12.
FreytagJ.RauscherE. A. (2017). The Importance of intergenerational communication in advance care planning: Generational relationships among perceptions and beliefs. Journal of Health Communication, 22(6), 488–496. https//doi.org/10.1080/10810730.2017.1311971
13.
FriedT. R.ZenoniM.IannoneL.O’LearyJ. R. (2019). Assessment of surrogates’ knowledge of patients’ treatment goals and confidence in their ability to make surrogate treatment decisions. JAMA Internal Medicine, 179(2), 267–268. https//doi.org/10.1001/jamainternmed.2018.5299
14.
GerstK.BurrJ. A. (2008). Planning for end-of-life care: Black-white differences in the completion of advance directives. Research on Aging, 30(4), 428–449. https//doi.org/10.1177/0164027508316618
15.
HanS. H.KimK.BurrJ. A. (2018). Social support and preventive healthcare behaviors among couples in later life. The Gerontologist, 59(6), 1162–1170. https//doi.org/10.1093/geront/gny144
16.
InfurnaF. J.MayerA. (2015). The effects of constraints and mastery on mental and physical health: Conceptual and methodological considerations. Psychology and Aging, 30(2), 432–448. https//doi.org/10.1037/a0039050
17.
InoueM. (2016). The influence of sociodemographic and psychosocial factors on advance care planning. Journal of Gerontological Social Work, 59(5), 401–422. https//doi.org/10.1080/01634372.2016.1229709
18.
InoueM.IharaE.TerrillionA. (2019). Making your wishes known: Who completes an advance directive and shares it with their health care team or loved ones?Journal of Applied Gerontology, 38(12), 1746–1762. https//doi.org/10.1177/0733464817748778
KossC. S. (2017). Beyond the individual: The interdependence of advance directive completion by older married adults. Journal of the American Geriatrics Society, 65(7), 1615–1620. https//doi.org/10.1111/jgs.14939
21.
KossC. S.BakerT. A. (2018). Where there’s a will: The link between estate planning and disparities in advance care planning by white and black older adults. Research on Aging, 40(3), 281–302. https//doi.org/10.1177/0164027517697116
22.
KossC. S.JensenD. (2020). Going it alone: Advance directive discordance in older married couples. Journal of Applied Gerontology, 39(12), 1274–1283. https//doi.org/10.1177/0733464819884439
23.
KwakJ.HaleyW. E. (2005). Current research findings on end-of-life decision making among racially or ethnically diverse groups. The Gerontologist, 45(5), 634–641. https//doi.org/10.1093/geront/45.5.634
24.
LachmanM.WeaverS. L. (1998). The sense of control as a moderator of social class differences in health and well-being. Journal of Personality and Social Psychology, 74(3), 763–773. https//doi.org/10.1037/0022-3514.74.3.763
25.
LachmanM. E.NeupertS. D.AgrigoroaeiS. (2011). The relevance of control beliefs for health and aging. In Handbook of the psychology of aging (7th ed., pp. 175–190). Elsevier Academic Press. https//doi.org/10.1016/b978-0-12-380882-0.00011-5
26.
LaddS. C. (2014). Systematic review of research literature on African Americans’ end-of-life healthcare preferences. Journal of African American Studies, 18(4), 373–397. https//doi.org/10.1007/s12111-013-9276-z
27.
LewisM. A.McBrideC. M.PollakK. I.PuleoE.ButterfieldR. M.EmmonsK. M. (2006). Understanding health behavior change among couples: An interdependence and communal coping approach. Social Science & Medicine, 62(6), 1369–1380. https//doi.org/10.1016/j.socscimed.2005.08.006
28.
LuP.KongD.LeeJ.ShelleyM. (2021). Advance directives completion among older American couples: A dyadic perspective on the role of cognitive function and other factors. Journals of Gerontology B Psychol Sci Soc Sci. 7, gbab077. https//doi.org/10.1093/geronb/gbab077
NarangA. K.WrightA. A.NicholasL. H. (2015). Trends in advance care planning in patients with cancer: Results from a national longitudinal survey. JAMA Oncology, 1(5), 601–608. https//doi.org/10.1001/jamaoncol.2015.1976
31.
O’RandA. M. (1996). The precious and the precocious: understanding cumulative disadvantage and cumulative advantage over the life course. The Gerontologist, 36(2), 230–238. https//doi.org/10.1093/geront/36.2.230
32.
OrlovicM.SmithK.MossialosE. (2019). Racial and ethnic differences in end-of-life care in the United States: Evidence from the Health and Retirement Study (HRS). SSM - Population Health, 7, 100331. https//doi.org/10.1016/j.ssmph.2018.100331
33.
PaiC.-W.Godboldo-BrooksA.EdingtonD. W. (2010). Spousal concordance for overall health risk status and preventive service compliance. Annals of Epidemiology, 20(7), 539–546. https//doi.org/10.1016/j.annepidem.2010.03.020
34.
PearlmanR. A.ColeW. G.PatrickD. L.StarksH. E.CainK. C. (1995). Advance care planning: eliciting patient preferences for life-sustaining treatment. Patient Education and Counseling, 26(1–3), 353–361. https//doi.org/10.1016/0738-3991(95)00739-m
35.
PenedoF. J.DahnJ. R. (2005). Exercise and well-being: A review of mental and physical health benefits associated with physical activity. Current Opinion in Psychiatry, 18(2), 189–193. https//doi.org/10.1097/00001504-200503000-00013
36.
RanbyK. W.AikenL. S. (2016). Incorporating husband influences into a model of physical activity among older women. British Journal of Health Psychology, 21(3), 677–693. https//doi.org/10.1111/bjhp.12195
37.
RosnickC. B.ReynoldsS. L. (2003). Thinking ahead: Factors associated with executing advance directives. Journal of Aging and Health, 15(2), 409–429. https//doi.org/10.1177/0898264303015002005
38.
SandersJ. J.RobinsonM. T.BlockS. D. (2016). Factors impacting advance care planning among African Americans: Results of a systematic integrated review. Journal of Palliative Medicine, 19(2), 202–227. https//doi.org/10.1089/jpm.2015.0325
SudoreR. L.SchickedanzA. D.LandefeldC. S.WilliamsB. A.LindquistK.PantilatS. Z.SchillingerD. (2008). Engagement in multiple steps of the advance care planning process: A descriptive study of diverse older adults. Journal of the American Geriatrics Society, 56(6), 1006–1013. https//doi.org/10.1111/j.1532-5415.2008.01701.x
41.
TenoJ. M.GruneirA.SchwartzZ.NandaA.WetleT. (2007). Association between advance directives and quality of end-of-life care: A national study. Journal of the American Geriatrics Society, 55(2), 189–194. https//doi.org/10.1111/j.1532-5415.2007.01045.x
42.
UtzR. L.BergC. A.ButnerJ. (2016). It’s a family affair: Reflections about aging and health within a family context. The Gerontologist, 57(1), 129–135. https//doi.org/10.1093/geront/gnw081
43.
YangY.LandK. C. (2006). A mixed models approach to the age-period-cohort analysis of repeated cross-section surveys, with an application to data on trends in verbal test scores. Sociological Methodology, 36(1), 75–97. https//doi.org/10.1111/j.1467-9531.2006.00175.x
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
