Abstract
Advance directives are used to communicate preferences about future life-sustaining treatment. Most research treats advance directive completion as an individual health behavior. Scholars have recently highlighted the importance of understanding how spouses may influence one another’s planning. Prior research suggests spousal heterogamy influences health behaviors. Using dyadic data from the Health and Retirement Study, we examined how spousal age, education, and health heterogamy related to discordant advance directive completion among heterosexual married couples (65+). Just under 30% of 1,611 couples displayed advance directive discordance. Odds of only one spouse possessing an advance directive increased when the wife was 3+ years older (OR = 1.74, p < .01) and when the wife had more education (OR=1.63, p<.01). Discordance was less likely when the husband was 3+ years older (OR=.63, p<.01). Gender-stratified models showed a woman was more likely to be the sole spouse with an advance directive when she had a higher level of education than her husband (OR=2.19, p<. 01) and when her health was worse (OR=1.63, p<.05). A man was more likely be the only spouse with an advance directive when he was more educated than his wife (OR=1.91, p<.01). Results suggest that age, education, and health heterogamy may contribute to older married adults completing advance directives separately from their spouses. The presenters view these data through a family development systems model to examine the degree to which couples negotiate actions around end-of-life decision-making. Should end-of-life preparation be a familial developmental task or an exercise of individual autonomy?