Older married couples and advance directives

Advance directives (ADs) are legal documents you can use to state in advance what medical treatments you do or do not wish to have under certain circumstances. You also can use an AD to name one or more people to act on your behalf if you are ever unable or uncomfortable making your own healthcare decisions.

Studies have shown that, at the end of life, people who have ADs receive less aggressive life-sustaining treatment and are less likely to be admitted to intensive care units, sometimes because those may not be options an older person wants to pursue. They are also more likely to die at home instead of in a hospital, and they receive hospice care earlier and for longer periods of time.

About 50 percent of people 65 and older in the United States have completed ADs. However, little is known about why some people have them while others do not. Most research treats the decision to complete an AD as an individual choice, but we know little about the roles that spouses and other family members may play in a person's decision to engage in end-of-life planning.

A new study examined the effects spouses had on the decision of older adults to have ADs. The study was published in the Journal of the American Geriatrics Society.

The study's researcher, Catheryn S. Koss, JD, PhD, of the Gerontology Center, University of Kansas, examined information from 2,243 married couples aged 65 and older who had participated in the Health and Retirement Study during 2004-2012.

In the study, Dr. Koss looked at how individual characteristics and characteristics of a person's spouse influenced whether older adults had ADs. These characteristics included:

• Age
• Education
• Poor health
• Prior hospitalizations and/or outpatient surgeries (those that don't require an overnight hospital stay)
• Having greater household assets

Among participants in the study, 57 percent of men and 56 percent of women had ADs. Both spouses had ADs in 46 percent of couples and neither had ADs in 33 percent of couples.

Some of the insights the study revealed include:

• Age (for an individual and his/her spouse) was linked to having an AD for both men and women.
• Men's education was associated with having their own AD and an AD for their wives.
• The worse a wife's health, the less likely a man was to have an AD.
• Hospitalization and/or outpatient surgery for men was associated with having an AD for both spouses.
• Women with regular healthcare providers were more likely to have an AD, but this did not hold true for men.

The results of this study suggest that having an AD among older married adults is affected both by the characteristics of individuals in a married relationship, as well as their joint experience as a couple. Furthermore, how spouses influence one another's advance care planning seems to differ by gender.