Beyond the Individual: The Interdependence of Advance Directive Completion by Older Married Adults

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To determine how individual and spousal demographic and health factors are associated with advance directive (AD) completion by married older adults.


Dyadic structural equation modeling using the Actor-Partner Interdependence Model.


The 2004 to 2012 waves of the Health and Retirement Study.


Community-dwelling heterosexual married couples aged 65 and older (N = 2,243).


Structural equation modeling with a probit link function was used to estimate associations between men's and women's age, education, health status, prior hospitalization or outpatient surgery in the past 10 years, regular health care provider, and household net assets and their own and their spouses’ probabilities of having an AD.


Individual and spousal ages were each positively associated with AD completion for men and women. Those with higher education were more likely to possess ADs. Women's probabilities of having ADs were also positively associated with husbands’ education. Men whose wives’ were in poor health were less likely to have ADs. Men who were hospitalized or underwent outpatient surgery were more likely to have ADs, as were their wives. Women who had regular sources of health care were more likely to have completed ADs.


AD completion by older married adults is associated with both individual and spousal factors. How spouses influence one another's advance care planning differs by gender. Future research should account for the dyadic nature of advance care planning, as should public education efforts and interventions promoting AD completion.

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