@article {11613, title = {Advance Directives Completion among Older American Couples: A Dyadic Perspective on the Role of Cognitive Function and Other Factors.}, journal = {The Journals of Gerontology, Series B}, volume = {77}, year = {2022}, pages = {1144-1153}, abstract = {

OBJECTIVE: Dyadic perspective is scarce in existing advance directive (AD) literature. Particularly, the significance of one{\textquoteright}s own and/or one{\textquoteright}s partner{\textquoteright}s cognitive function on AD remains unknown. This study investigates the relationship of cognitive function and other factors with AD completion within the spousal context.

METHODS: Data from the Health and Retirement Study (2014-2015) were used. Older heterosexual couples (age >=65) married for 10+ years were asked if they had a living will and/or appointed a durable power of attorney for healthcare (DPAHC). Structural Equation Models examined the actor and partner effects of sociodemographic, health, and couple-level characteristics on wife{\textquoteright}s and husband{\textquoteright}s AD, respectively.

RESULTS: Moderate spousal interdependence was observed in living will (Kappa coefficient, k =0.60) and DPAHC (k=0.53). Older age and higher education were related to both spouses having AD. Less household wealth and being racial/ethnic minority were associated with a lower probability of having AD. Notable gender contrasts in actor and partner effects were found. Wife{\textquoteright}s higher level of cognitive function was associated with husband{\textquoteright}s AD completion. Contrarily, husband{\textquoteright}s lower level of cognitive function was associated with wife{\textquoteright}s AD completion. Retirement status had primarily actor effects for both husbands and wives. More chronic conditions were linked to husband{\textquoteright}s AD completion.

DISCUSSION: The spousal interdependence of AD warrants practitioner efforts to facilitate family-oriented end-of-life planning. Wives and husbands may have different thoughts regarding their spouse{\textquoteright}s cognitive capacity to surrogate. Facilitating couple-based discussions may be a feasible approach to promote engagement with AD among older adults.

}, keywords = {actor-partner interdependence model, advance directive, Couples, dyadic analysis}, issn = {1758-5368}, doi = {10.1093/geronb/gbab077}, author = {Lu, Peiyi and Kong, Dexia and Lee, Jeongeun and Shelley, Mack} }