Lou Yifan, Carr Deborah
School of Social Work, Columbia University, New York, New York, USA.
Department of Sociology, Boston University, Boston, Massachusetts, USA.
J Gerontol B Psychol Sci Soc Sci. 2022 Aug 11;77(8):1508-1518. doi: 10.1093/geronb/gbac003.
Persistent race disparities in advance care planning (ACP) are troubling, given Black and Hispanic older adults' elevated risk of disease, some dementias, and receipt of care that may not align with their preferences. A potentially important yet underexplored explanation for these disparities is subjective life expectancy (SLE) or beliefs about one's future survival that may impel or impede ACP.
Data are from the Health and Retirement Study (n = 8,912). We examined the extent to which perceived chances of living another 10 years are associated with 3 components of ACP (living will, durable power of attorney for health care [DPAHC], and informal discussions). We used multilevel logistic regression models to evaluate the extent to which SLE mediates the association between race and ACP, adjusting for demographic, socioeconomic, psychosocial, and health characteristics.
Black and Hispanic older adults have significantly lower rates of ACP relative to Whites. These disparities persist even when SLE is controlled. Blacks report especially optimistic whereas Hispanics report pessimistic survival expectations, although these differences do not explain racial disparities in ACP. SLE has direct effects on ACP, such that persons who report an "uncertain" SLE are less likely to have a living will or a DPAHC, whereas those who perceive a 50% chance of survival have significantly greater odds of discussions, relative to those who perceive a 0% chance of survival.
Doctor-patient conversations about the likely course of one's illness may inform patients' knowledge of their SLE, which may motivate timely ACP.
鉴于黑人和西班牙裔老年人疾病风险升高、患某些痴呆症的风险增加，以及接受的护理可能不符合他们的偏好，预先护理计划（ACP）中持续存在的种族差异令人担忧。这些差异的一个潜在重要但未充分探讨的解释是主观预期寿命（SLE），即对自己未来生存的信念，它可能推动或阻碍ACP。
数据来自健康与退休研究（n = 8,912）。我们研究了认为自己再活10年的可能性与ACP的三个组成部分（生前预嘱、医疗保健持久授权书[DPAHC]和非正式讨论）之间的关联程度。我们使用多层次逻辑回归模型来评估SLE在多大程度上介导了种族与ACP之间的关联，并对人口统计学、社会经济、心理社会和健康特征进行了调整。
相对于白人，黑人和西班牙裔老年人的ACP发生率显著较低。即使控制了SLE，这些差异仍然存在。黑人报告的生存预期尤其乐观，而西班牙裔报告的生存预期则较为悲观，尽管这些差异并不能解释ACP中的种族差异。SLE对ACP有直接影响，例如，报告“不确定”SLE的人拥有生前预嘱或DPAHC的可能性较小，而认为有50%生存机会的人进行讨论的几率相对于认为生存机会为0%的人显著更高。
医患之间关于疾病可能病程的对话可能会让患者了解自己的SLE，这可能会促使他们及时进行ACP。
