"Till Death Do Us Part", Dying Matters, Beyond the Individual: Advance Care Planning Patterns Among Older Couples

Objective We examined the formal and informal advance care planning (ACP) patterns of older couples and determined how these patterns are associated with individual and spousal characteristics. Methods Using data from the 2014 and 2016 Health and Retirement Study, we performed latent class analysis to identify ACP patterns and multinomial regression models to describe characteristics of older couples (N = 2195 couples). Results We identified four ACP patterns: high engaging couple (47%); high engaging husband-low engaging wife (11%); high engaging wife-low engaging husband (11%); and low engaging couple (31%). High engaging couples were more likely to be older, educated, and financially better off, whereas high ACP engagement in discordant ACP patterns was associated with health and wives' constraints. Discussion A couple-based approach was recommended to promote the merits of ACP where spouses were older, had limited resources, or where one or both partners were suffering from poor health.