Department of Sociology, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey 08901, USA.
J Gerontol B Psychol Sci Soc Sci. 2013 Jul;68(4):586-92. doi: 10.1093/geronb/gbt034. Epub 2013 May 20.
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.
医疗专业人员通常将预先护理计划（ACP）视为个体层面的活动，但家庭成员在决定老年人的临终护理方面也可能发挥重要作用。我们评估了婚姻满意度和亲子关系质量对老年人使用预先指示（即生前遗嘱和医疗保健持久授权书 [DPAHC] 任命）和临终讨论的影响。
我们使用多项逻辑回归模型和来自威斯康星州纵向研究的 1883 名老年人样本的数据，估计了婚姻满意度、来自子女的情感支持和批评、其他社会支持、人口统计学特征和健康状况对一般 ACP（即仅预先指示、仅讨论、两者兼有或两者都没有）和特定 DPAHC 任命的影响。
亲子关系有问题的父母不太可能完成 ACP，而婚姻满意度与完成预先指示和讨论均呈正相关。婚姻幸福的人更有可能指定配偶为 DPAHC，而从子女那里获得大量情感支持的人则最有可能指定成年子女。
家庭动态以复杂的方式影响 ACP，应在医患讨论临终关怀时考虑到这一点。
