Going It Alone: Advance Directive Discordance in Older Married Couples

TitleGoing It Alone: Advance Directive Discordance in Older Married Couples
Publication TypeJournal Article
Year of Publication2019
AuthorsKoss, CS, Jensen, D
JournalJournal of Applied Gerontology
Date Published2019/10/28
ISBN Number0733-4648
KeywordsAdvance directives, Couples

Contrary to expectations of joint decision-making, a substantial minority of older married couples report only one spouse possessing an advance directive. Using Health and Retirement Study data, the authors examined advance directive discordance among heterosexual married couples in which at least one spouse had completed an advance directive. It was predicted that spouses who differed in age, self-rated health, or race/ethnicity would be more apt to adopt individualistic as opposed to relational motivational stances, resulting in higher odds of nonmatching advance directive status. Heterogamy did not account for discordance, but couples in which one or both spouses attended some college were more likely to report advance directive concordance. In contrast, couples in which one or both spouses were non-White were more likely to display advance directive discordance. Study results raise concerns about the effectiveness and reach of advance care planning promotion efforts among low-education and non-White older married adults.


doi: 10.1177/0733464819884439

Short TitleJ Appl Gerontol
Citation Key10401