Disparities in Advance Care Planning Across Rurality, Sociodemographic Characteristics, and Cognition Levels: Evidence from the Health and Retirement Study

Abstract

Background: We aimed to examine ACP in older adults in the U.S. across different sociodemographic characteristics and cognition levels (N = 17,698). Methods: We utilized two legal documents from the Health and Retirement Study survey: a living will and durable power of attorney for healthcare (DPOAH). We established the baseline trends from 2014 to assess if trends in 2024 have improved upon future data availability. Logistic regression models were fitted with outcome variables (living will, DPOAH, and both) stratified by cognition levels (dementia/impaired cognition versus normal cognition). Results: Age, ethnicity, race, education, and rurality were significant predictors of ACP (having a living will, DPOAH, and both the living will and DPOAH) across cognition levels. Participants who were younger, Hispanic, black, less educated, or resided in rural areas were less likely to complete ACP. Conclusion: Examining ACP and its linkages to specific social determinants is crucial for understanding disparities and developing effective educational and interventional strategies to enhance ACP uptake among diverse population groups. Future studies are needed to assess whether disparities have improved over the last decade, particularly as 2024 data become available. Addressing ACP disparities is essential for healthcare professionals to advance research and promote effective practices in geriatric care and aging services.