THE LAST DECADE: LONGEVITY EXPECTATIONS, DEATH ATTITUDES, AND HEALTH CARE USE

Death becomes exponentially more probable with each year of aging. Acknowledging
this when making health care decisions has important consequences for quality of life, as the
benefits of care may not outweigh the costs if little time remains to enjoy those benefits. Death
expectations across the lifespan influence how people prepare for and experience death, but little
is known about the trajectories of death expectations in the final years of life and how those
trajectories relate to health care use. Using biennial subjective survival probability (SSP) ratings
gathered over the decade prior to death from participants ages 65 and older in the Health and
Retirement Study (HRS), latent profile analyses (LPA) were used to identify profiles of
participants using meaningful subgroups. The optimal solution included four distinct profiles of
SSP trajectories labeled realists, non-commitals, pessimists, and optimists. A series of t-test, chisquare, one-way ANOVA, and repeated measures ANOVA analyses were then conducted to
identify characteristic features of the groups and assess for any differences in health care
behaviors and death attitudes. Results demonstrated that two of four profiles had a significant
increase in SSP from wave four to wave five: the optimists and non-committals. The pessimists
were older at death than non-committals and realists, and were more likely to have had a final
illness duration of more than a year than the full sample; pessimists had worse self-perceptions
of health than optimists and realists; optimists were less likely to have a living will than the full
sample and more likely to identify as African American than their representations in the full
sample; and optimists reported fewer depressive symptoms and health conditions than
pessimists. I also hypothesized that SSPs during the last decade of life would predict health care
use in the same period and that optimists and realists would use more health care health care than
pessimists; these hypotheses were not confirmed.