“Till Death Do Us Part”,Dying Matters,Beyond the Individual: Advance Care Planning Patterns Among Older Couples

Abstract

Objective

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.

Keywords

end-of-life conversation advance care planning spousal concordance latent class analysis

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References

Berkman

L. F.

Glass

Brissette

Seeman

T. 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

Bischoff

K. E.

Sudore

Miao

Boscardin

W. J.

Smith

A. 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

Boerner

Carr

Moorman

(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

Boerner

Moorman

S. M.

Carr

Ornstein

K. 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

Brinkman-Stoppelenburg

Rietjens

J. A.

van der Heide

(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

Carr

(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

Carr

Luth

E. A.

(2017). Advance care planning: Contemporary issues and future directions. Innovation in Aging, 1(1), igx012. https//doi.org/10.1093/geroni/igx012

Carr

Moorman

S. M.

Boerner

(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

Cohen

(2004). Social relationships and health. The American Psychologist, 59(8), 676–684. https//doi.org/10.1037/0003-066x.59.8.676

10.

Drewelies

Chopik

W. J.

Hoppmann

C. A.

Smith

Gerstorf

(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.

Elder

G. 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.

Freytag

Rauscher

E. 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.

Fried

T. R.

Zenoni

Iannone

O’Leary

J. 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.

Gerst

Burr

J. 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.

Han

S. H.

Kim

Burr

J. 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.

Infurna

F. J.

Mayer

(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.

Inoue

(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.

Inoue

Ihara

Terrillion

(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

19.

Kelly

C. M.

Masters

J. L.

DeViney

(2013). End-of-life planning activities: An integrated process. Death Studies, 37(6), 529–551. https//doi.org/10.1080/07481187.2011.653081

20.

Koss

C. 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.

Koss

C. S.

Baker

T. 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.

Koss

C. S.

Jensen

(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.

Kwak

Haley

W. 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.

Lachman

Weaver

S. 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.

Lachman

M. E.

Neupert

S. D.

Agrigoroaei

(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.

Ladd

S. 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.

Lewis

M. A.

McBride

C. M.

Pollak

K. I.

Puleo

Butterfield

R. M.

Emmons

K. 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.

Kong

Lee

Shelley

(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

29.

McCammon

R. J.

Fisher

G. G.

Hassan

Faul

J. D.

Rogers

Weir

D. R.

(2019). Health and retirement study imputation of cognitive functioning measures: 1992–2016. http://hrsonline.isr.umich.edu/modules/meta/xyear/cogimp/desc/COGIMP9216_dd.pdf

30.

Narang

A. K.

Wright

A. A.

Nicholas

L. 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’Rand

A. 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.

Orlovic

Smith

Mossialos

(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.

Pai

C.-W.

Godboldo-Brooks

Edington

D. 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.

Pearlman

R. A.

Cole

W. G.

Patrick

D. L.

Starks

H. E.

Cain

K. 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.

Penedo

F. J.

Dahn

J. 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.

Ranby

K. W.

Aiken

L. 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.

Rosnick

C. B.

Reynolds

S. 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.

Sanders

J. J.

Robinson

M. T.

Block

S. 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

39.

Skinner

E. A.

(1996). A guide to constructs of control. Journal of Personality and Social Psychology, 71(3), 549–570. https//doi.org/10.1037/0022-3514.71.3.549

40.

Sudore

R. L.

Schickedanz

A. D.

Landefeld

C. S.

Williams

B. A.

Lindquist

Pantilat

S. Z.

Schillinger

(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.

Teno

J. M.

Gruneir

Schwartz

Nanda

Wetle

(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.

Utz

R. L.

Berg

C. A.

Butner

(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.

Yang

Land

K. 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

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