Departments of Medicine, Health, and Society and Sociology, Vanderbilt University, Nashville, Tennessee, USA.
Department of Sociology and Center for Innovation in Social Science, Boston University, Boston, Massachusetts, USA.
J Gerontol B Psychol Sci Soc Sci. 2024 Oct 1;79(10). doi: 10.1093/geronb/gbae141.
Advance care planning (ACP), which comprises a living will, durable power of attorney for healthcare (DPAHC), and end-of-life discussions, is an inherently relational process. However, it is unclear how marital status affects men's and women's ACP over the life course. Drawing on social control and gender-as-relational frameworks, we examine marital status differences in ACP and how these patterns differ by gender and age.
Data are from the 2020 Health and Retirement Study (HRS), a representative sample of U.S. older adults (N = 7,074). We estimate logistic regression models to evaluate whether marital status differences in ACP are moderated by age and gender, and multinomial logistic regressions to examine age and gender differences in DPAHC designations among married parents. Analyses are adjusted for sociodemographic and health covariates.
Multivariable analyses revealed significant moderation effects for discussions only. Among married/cohabiting persons, women are more likely than men to have end-of-life discussions, with gender differences diminishing slightly at oldest ages. Among divorced persons in their 60s and 70s, women are much more likely than men to have had discussions, although this gap converges among the oldest-old. Conversely, young-old widowed men and women are equally likely to have discussions, although women are increasingly likely to do so with advancing age. Men are more likely than women to name their spouse as DPAHC, yet this gap diminishes with age.
Healthcare providers can better guide end-of-life consultations if they understand how men's and women's family relationships change with advancing age.
预先医疗指示（ACP）包括生前预嘱、医疗保健持久授权书和临终讨论，是一个本质上具有关系性的过程。然而，婚姻状况如何影响男性和女性在整个生命周期中的 ACP 尚不清楚。本研究借鉴社会控制和性别关系框架，考察了 ACP 中婚姻状况的差异，以及这些模式如何因性别和年龄而异。
数据来自 2020 年健康与退休研究（HRS），这是美国老年人群体的代表性样本（N=7074）。我们使用逻辑回归模型评估 ACP 中婚姻状况差异是否受到年龄和性别的调节，以及多元逻辑回归模型评估已婚父母中 DPAHC 指定的年龄和性别差异。分析调整了社会人口统计学和健康协变量。
多变量分析显示仅讨论存在显著的调节效应。在已婚/同居者中，女性比男性更有可能进行临终讨论，性别差异在最年长的年龄略有缩小。在 60 多岁和 70 多岁的离婚者中，女性比男性更有可能进行讨论，尽管在最年长的年龄组中这种差距会缩小。相反，年轻的丧偶男性和女性同样有可能进行讨论，尽管女性随着年龄的增长越来越有可能这样做。男性比女性更有可能指定配偶为 DPAHC，但这一差距随着年龄的增长而缩小。
如果医疗保健提供者了解男性和女性的家庭关系如何随着年龄的增长而变化，他们可以更好地指导临终咨询。
