Preparation For Future Care Research Articles

Racial differences in the effect of verbal and nonverbal memory on concrete planning for future care needs among older adults: a multi-group structural equation modeling approach

ABSTRACT Concrete planning for future care needs may positively impact older adults’ subsequent mental health and quality of life. However, the cognitive factors that facilitate concrete planning among Black and White older adults are still poorly understood. We investigated whether there are significant differences between Black (n = 159) and White (n = 262) older adults in concrete planning and explored racial differences in the relationship between verbal and nonverbal episodic memory and concrete planning. Results revealed that Blacks showed lower engagement in concrete planning and lower scores than Whites on each verbal and nonverbal memory task. For Blacks, but not Whites, verbal memory and nonverbal memory performance predicted concrete planning with higher nonverbal memory relating to less concrete planning and higher verbal memory associated with more concrete planning. Our findings suggest racial differences exist in how episodic verbal and nonverbal memory affect concrete planning, a crucial factor for older adults’ preparation for future care.

Patterns of Intergenerational Care Planning Among Chinese Aging Families in Hong Kong

Care planning before the onset of intensive care needs can increase families’ ability to manage caregiving crises and cope with care transitions. However, future care planning has not been substantially examined in a family context. Drawing on the model of Preparation for Future Care Needs and a family systems perspective, this study investigated patterns of intergenerational care planning across multiple planning domains (awareness, avoidance, information gathering, decision making, and concrete planning) among Chinese intergenerational pairs. Quantitative data of 213 pairs of aging parents and adult children were collected in Hong Kong. Latent Profile Analysis was conducted to examine typological structure underlying care planning patterns. Three patterns were discovered: filial-maximal, dyadic-moderate, and filial-minimal. Profile 1 contained approximately 9.9% of pairs, which demonstrated a relatively higher level of avoidance on considering the need of care preparation and engaged less in concrete planning activities. Profile 2 contained 68.5% of intergenerational pairs that had a moderate preparation level. Profile 3 contained 21.6% of intergenerational pairs that were comparatively active in care planning. The findings also indicated that although older adults across three groups demonstrated a similar level of awareness to prepare for future care, their engagement in the concrete planning activities may be driven by their children’s awareness and preparation toward future care. The findings will enhance professionals’ and service providers’ awareness of diverse care planning patterns among Asian aging families, and inform targeted policies and programmes to alleviate unpreparedness for eldercare through intergenerational care planning which can be more effective than unilateral preparation.

Preparation for Future Care Needs in Middle-Aged and Older Adults: What Promotes Feeling of Preparedness?

To examine whether demographic, dementia-related, and control-related variables predict preparation for future care needs (PFCN) in a sample of middle-aged and older adults. PFCN is defined in this study as a self-perceived sense of preparedness for one's own future care needs, including general awareness of future care needs, gathering relevant information, decision-making about care preferences, concrete planning, and non-avoidance of care planning. Participants (N = 122; age 40 to 88 years: M = 65.83, SD = 9.80) completed self-report measures in an in-person study. Hierarchical multiple regression was calculated to predict PFCN. Being female, having more positive dementia attitudes, higher attribution to powerful others for health condition(s), and more completed end-of-life (EOL) planning significantly predicted greater PFCN. Findings indicate a positive relationship between objective (completed EOL planning items) and subjective (PFCN) components of planning, thus highlighting the importance of taking concrete steps in EOL planning to yield greater feelings of preparedness, which has been associated with positive psychological outcomes.

Patterns and Predictors of Preparation for Future Care Among Older Rural Chinese Adults: A Latent Profile Analysis.

This study aimed to identify profiles of preparation for future care (PFC) among older rural Chinese adults. A total of 481 older adults were recruited. PFC was evaluated using Preparation for Future Care Needs and respondents' social services knowledge. Information on individual characteristics, physical health indicators, mental health, and support system was collected. Four profiles of PFC were identified: scarce-preparation (22.42%), high-avoidance/low-action (26.91%), moderate-preparation (44.17%), and high-avoidance/high-action (6.50%). The scarce-preparation and high-avoidance/low-action profiles had the lowest levels of social services knowledge. Multinomial logistic regression showed that older adults in moderate-preparation and high-avoidance/high-action profiles had fewer illnesses, exercised more frequently, and had higher loneliness levels compared with those in the scarce-preparation profile. Compared with high-avoidance/low-action persons, high-avoidance/high-action persons had fewer illnesses, exercised more frequently, and had lower self-esteem and higher loneliness levels. People who performed poorly in physical health indicators and well in mental health need to increase PFC.

Does Caregiving Influence Planning for Future Aging?: A Mixed Methods Study Among Caregivers in Canada.

A mixed method design was used to examine how caregiving and transitioning a family member into long-term care (LTC) influence planning. Participants, aged 50+ from the community, completed self-report questionnaires. Quantitative data evaluated differences between three groups (non-caregivers, caregivers, caregivers with experience in assisting with a LTC transition); and predictive effects of caregiving, care expectations and social support to planning. Interviews among a subsample of caregivers examined how experiences of caregiving, including assisting in a transition to LTC, and social support influenced planning. Results indicated that: (1) caregivers with LTC transition experience planned significantly more than non-caregivers, (2) caregiving, care expectations, and social support significantly predicted of planning, and (3) future care expectation was an important mechanism in the relationship between caregiving and planning. These findings underscore the impact of caregiving experiences on expectations of future care needs and preparation for future care needs, and the importance of social support.

Preparation for future care moderates the relationship between loneliness and depression among Chinese rural older adults: A cross-sectional study

Loneliness has been identified as a risk factor for depression, while preparation for future care (PFC) can be a protective factor. Little is known about their complex relationships in older adults in China. This study aimed to explore whether PFC moderated the association between loneliness and depression. A total of 481 older adults aged 60 years and above were recruited in rural Shandong, China. After excluding those whose data missing rates were over 15%, data were analyzed for a total of 436 participants. Loneliness, PFC, and depression were measured. Statistical analyses included descriptive analysis, and moderating effects analyses. Our findings showed that PFC and its related dimensions can moderate the relationship between loneliness and depression. When the level of PFC and its dimensions were higher, the effect of loneliness on depression was weaker. PFC should be taken into consideration when interventions are being developed to reduce depression in older adults.

Preparation and Planning for Future Care in the Deep South: Adapting a Validated Tool for Cultural Sensitivity.

This study describes the adaptation and validation of Sörensen et al. (2017)'s preparation for future care (PFC) scale with diverse samples including rural dwelling African Americans and certified nursing assistants (CNAs), and subsequent psychometric development. Responses to the five-subscale PFC survey from 33 rural African American men across 12 months and cognitive interviews with a subset of 12 of these men are described. Psychometric refinement included descriptive qualitative analyses of consultations with experienced lay research advisors (N = 4 and N = 7) regarding potential changes to the PFC and a confirmatory factor analysis of the resultant scale (N = 138). Cognitive interviews with rural African American men revealed difficulty understanding Eurocentric questions. Emergent themes included emotional avoidance of planning, considerations of nursing homes and possible care providers, and coping strategies. In two consultation meetings, trained lay research advisors recommended language modifications to the original questions and response options. Factor analyzing the resultant scale revealed support for the original subscale constructs (acceptable fit: χ2 = 205.03, df = 124, p < .001; root mean square error of approximation = .069 [.052-.085]; comparative fit index = .93; Tucker-Lewis index = .91). PFC and engagement in advance care planning is uncommon among African Americans, possibly due to distrust of and lack of cultural competency among health care professionals. The resulting tool and response options may be used as an interview guide/survey with African Americans to gain understanding about their preparation for future health care needs.

Assessing future care preparation in late life: Two short measures.

The purpose of this article is to introduce 2 short forms of the previously published measure of preparation for future care (PFC). Community-dwelling older adults ages 65-94 who had completed the 29-item Preparation for Future Care Needs scale were randomly divided into scale development (n = 697) and scale validation (n = 690) samples. Fifteen items were selected using exploratory and confirmatory factor analyses on the scale development and scale validation samples, respectively. Consistent with PFC theory, the 5 subscales of the original long-form measure (Awareness, Gathering Information, Decision Making, Concrete Planning, Avoidance of Care Planning) were maintained. A 5-item scale with acceptable score reliability and validity was also developed. Compared to the long form, these short forms are more easily incorporated into epidemiologic studies and can be used in medical, psychology, and social work practice to initiate discussions about long-term care planning. (PsycINFO Database Record

Family Support and Preparation for Future Care Needs Among Urban Chinese Baby Boomers.

Little is reported about the family's role in preparation for future care (PFC) before the onset of care needs. The primary aim was to examine the relationships between PFC and different types of family support exchanged with generations both above and below. Path analysis was conducted on 516 Chinese baby boomers aged 45-65 to examine the associations between PFC (care expectation, awareness, information gathering, and decision making) and 4 types of family support (instrumental support, financial assistance, information and appraisal, and emotional support) when the covariates were controlled for. The current planning status and planning paths are consistent with those of the U.S. and European populations. Providing instrumental support to a parent was positively associated with awareness of care needs. Providing emotional support to a child was negatively associated with information gathering. In general, receiving support from a child facilitated PFC. Although those receiving emotional support from an adult child had less awareness of care needs, they displayed more information gathering. The role of family support in PFC is more subtle than simply increasing and decreasing resource volumes. Future research is needed to better understand this complexity.

Trait Hope and Preparation for Future Care Needs among Older Adult Primary Care Patients

ABSTRACTObjective: We examined associations between trait hope and preparation for future care needs (PFCN) among 66 older adult primary care patients in western New York.Methods: Participants completed a questionnaire assessing PFCN (awareness, information gathering, decision-making, concrete planning, and avoidance), and the Adult Trait Hope Scale.Results: In multivariate regressions, lower hope, particularly less agency, was associated with more awareness of needing care, whereas higher hopefulness, particularly pathways thinking, was associated with increased decision-making and concrete planning.Conclusions: Greater hopefulness appears to be linked to goal-directed planning behaviors, although those with lower hope may actually be more aware of the need for planning. Evidence-based programming that encourages learned hopefulness may contribute to enhanced health planning and decision-making among older adult primary care patients.

Prepared to care: adult attachment and filial obligation

Objectives: Past work found that close adult attachment dimension scores predict caregiver preparedness. Theory and past research suggests filial obligation (FO) may mediate the relationship between attachment and caregiver preparedness. The goal of this study was to test that hypothesis.Method: The sample, collected using Mechanical Turk, included 165 women between the ages of 45 and 65 years who were not providing care to an aging parent. Participants were reimbursed $0.75 for completing an online survey assessing response validity, dimensions of adult attachment, depressive symptomatology, FO, and caregiver preparedness, among other variables. The mean participant age was 52.2 years (SD = 5.5).Results: The sample was predominantly White/Caucasian (82.6%), and Black/African American (7.3%). With respect to education, 14.5% completed high school or general education development (GED), 32.7% completed some college, 36.4% completed a Bachelor's degree, and 15.7% completed graduate degrees. The three attachment dimensions (close, dependent, and anxious) and FO were all significantly inner-correlated. Stepwise multiple regression analyses found that FO fully mediates the relationship between close attachment and caregiver preparedness, even after controlling for age, education, income, depression, and birth order.Conclusion: The primary finding is that FO mediates the relationship between close attachment style and caregiver preparedness among prospective caregivers. This suggests that individual differences in attachment style among prospective caregivers indirectly predict preparedness for future caregiving through FO, suggesting a mechanism relating attachment style and preparation for future care.

Optimism and Planning for Future Care Needs among Older Adults.

Aging is associated with an increase in need for assistance. Preparation for future care (PFC) is related to improved coping ability as well as better mental and physical health outcomes among older adults. We examined the association of optimism with components of PFC among older adults. We also explored race differences in the relationship between optimism and PFC. In Study 1, multiple regression showed that optimism was positively related to concrete planning. In Study 2, optimism was related to gathering information. An exploratory analysis combining the samples yielded a race interaction: For Whites higher optimism, but for Blacks lower optimism was associated with more planning. High optimism may be a barrier to future planning in certain social and cultural contexts.

Trajectories of Preparation for Future Care Among First-Degree Relatives of Alzheimer's Disease Patients: An Ancillary Study of ADAPT

This study examines the longitudinal patterns of Preparation for Future Care (PFC), defined as Awareness, Avoidance, Gathering Information, Decision Making, and Concrete Plans, in first-degree relatives of people with Alzheimer's disease (AD). Eight time points across 6.5 years from a subsample of adults aged 70 years and older who were participating in the Alzheimer's Disease Anti-inflammatory Prevention Trial (ADAPT) were analyzed using latent growth modeling. Baseline attitudes toward planning for future care and demographic variables functioned as predictors in the conditional analyses. Awareness, Gathering Information, Decision Making, and Concrete Planning increased across time, but Avoidance did not. Covariates were more often associated with the initial levels of planning behavior than with change across time. Women engaged in more initial Decision Making than men. Education was associated with more initial Gathering Information, Decision Making, and less Avoidance. Favorable attitudes toward planning were more predictive of baseline Awareness, Gathering Information, Avoidance, and less so for Decision Making or Concrete Planning. Older adults with an elevated risk for AD increase in positive PFC behaviors gradually across time. Demographic characteristics and attitudes predict initial levels of planning, making it possible to identify individuals who might need help progressing to more advanced levels of planning. Future studies are needed to understand rates of change in planning behaviors.

Planning and Decision Making for Care Transitions.

The need to plan for future health care and residential adjustments increases with age, growing frailty, and restrictions in coverage of long-term care and will continue to grow with population aging. Older adults' lack of financial preparation for health care costs, insufficient knowledge about available options, and inadequate communication about care-related values has become an increasing public health challenge. This chapter describes a model of Preparation for Future Care (PFC), which encompasses different levels and domains of planning. Research about the extent to which planning is helpful in navigating care transitions is reviewed, and barriers and facilitators of planning including individual, familial, cultural, and national long-term care policy factors are discussed. Planning in the context of dementia and practical approaches that can be taken to enhance PFC is addressed, as well as recommendations for future research in the area of planning and decision making in the context of care transitions.

How Are Personality Traits Related to Preparation for Future Care Needs in Older Adults?

We investigated associations between personality and health cognitions and behaviors related to preparation for future care among 355 primary care patients who were 65 years of age and older. Path analyses examined the effects of the personality traits of neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness on health cognitions about future care (avoidance, awareness), health-planning behaviors (gathering information, decision making, and planning), and beliefs about planning, while covarying age, gender, education, medical burden, functional status, and depression-symptom severity. Higher levels of neuroticism, openness, and agreeableness were associated with greater awareness of care needs; higher openness was also associated with more gathering of information and less avoidance. Extraversion and conscientiousness were not related to future-oriented health cognitions. Depression was inversely associated with the gathering of information. Age and education were related to more positive beliefs about the planning. Neither concrete planning nor decision making were related to personality variables. Health professionals should consider the impact of individual differences when addressing preparation for future care with older adults.

Preparation for Future Care Needs by Parents Providing Care for their Adult Offspring with Disabilities

Older adults who provide care for an adult child with a disability have rarely been considered when investigating propensity to plan for future care. Families in these circumstances are at risk of experiencing a crisis as these caregiving parents experience personal health challenges. This study investigated influences on the plans made by adults caring for adult offspring with a disability for their own as well their offspring's future care. Results indicated that parents who cared for an adult child with a disability were more likely to plan for their offspring's than their own care and the more planning they did for their adult child, the more they were likely to do for themselves. Implications are discussed.

National and regional differences in preparation for future care needs: a comparison of the United States and Germany.

Planning for future care needs is likely to be influenced by both policy and culture. We compared attitudes regarding the usefulness of planning ahead for future care needs, processes of preparation for these needs (becoming aware of the risk of future care needs, gathering information about available options, deciding on preferences, concrete planning), and outcomes of preparation (e.g., knowledge about services) in 294 East German, 288 West German, and 590 American seniors. American respondents had higher preparation scores. Compared to the size of national differences, differences between East and West German seniors were generally smaller. East Germans made fewer decisions on preferences and engaged in less concrete planning. Most of the national and regional differences in preparation for future care needs were reduced or eliminated by controlling for differences in the perceived usefulness of planning.

Developing a Measure of Older Adults' Preparation for Future Care Needs

We developed a measure of preparation for future care needs (PFCN) which consists of three parts: a) attitudes regarding the usefulness of planning for future care needs and toward the risk of needing help or care in the future; b) processes of preparation (becoming aware of future care needs, avoidance of preparation, gathering information, developing preferences, concrete planning); and c) contents of planning for short- and long-term care needs. Validity data of the questionnaire are reported based on 590 older adults (65-92 years). Engaging in preparation processes was associated with habitual decision styles, higher satisfaction with preparation, and greater knowledge of services. Greater vulnerability to needing future care was associated with higher expectations of needing care and more preparation. Internal consistency and stability of the measure based on 96 seniors was acceptable for almost all scales.

Preparation for future care needs: styles of preparation used by older Eastern German, United States, and Canadian women.

Many older persons have chronic conditions and limitations in their everyday functioning. While some individuals prepare for their future care needs, many others do not. Using semi-structured, qualitative interviews, discourse about dealing with the risk for needing help or care in the future was investigated in 23 East German, 10 U.S., and 12 Canadian elderly community-dwelling women (> or =65 years). Eighty percent had thought about future care needs; 64% had made general plans for their future care. Four preparation styles were identified in the three social-structural contexts: Avoidance of preparation, thinking without planning, short-term planning, and long-term planning. Individuals using these styles differed in their subjective assessment of preparation as well as in objective personal conditions. More similarities than differences were found between German, U.S. and Canadian women in the use of these styles. Results suggest that limited resources, system instability, and personal characteristics contribute to the choice of planning style.