End-of-life planning in a family context: does relationship quality affect whether (and with whom) older adults plan?

Abstract

Medical professionals typically approach advance care planning (ACP) as an individual-level activity, yet family members also may play an integral role in making decisions about older adults' end-of-life care. We evaluate the effects of marital satisfaction and parent-child relationship quality on older adults' use of advance directives (i.e., living will and durable power of attorney for health care [DPAHC] appointments) and end-of-life discussions. Using multinomial logistic regression models and data from a sample of 1,883 older adults in the Wisconsin Longitudinal Study, we estimated the effects of marital satisfaction, emotional support and criticism from children, other social support, demographic characteristics, and health on general ACP (i.e., advance directive only, discussions only, both, or neither) and specific DPAHC appointments. Parents with problematic parent-child relationships were less likely to complete ACP, and marital satisfaction was positively associated with completion of both advance directives and discussions. Happily married persons were more likely to appoint their spouse as DPAHC, whereas persons who received ample emotional support from children were mostly likely to appoint an adult child. Family dynamics affect ACP in complex ways and should be considered in patient-provider discussions of end-of-life care.