Making Your Wishes Known: Who Shares Their Advance Directives with Their Health Care Team or Loved Ones?

Background and Purpose: The importance of having an advance directive has been well documented in the literature, and factors that are associated with its completion, such as age and socioeconomic status, have also been noted. Another critical step for people to take in order to have their wishes carried out is sharing their advance directives with their health care providers and loved ones. Advance directives include a living will and durable power of attorney for healthcare (DPAHC). The purpose of this study is to examine factors that are associated with shared advance directives.

Methods: This study used data from the 2014 United States of Aging Survey, which is based on 3,250 phone interviews. The study examined a sample of 1,153 older adults aged 60 or older who were randomly selected from 3,250 individuals and asked questions related to end-of-life care planning. The dependent variable was a nominal variable, shared advance directives, with the following three categories: those who had no advance directive, those who had an unshared advance directive (reference group), and those who had an advance directive that had been shared with their loved ones or health care team. A person who had completed either a living will or DPAHC was considered to be a person with an advance directive. Independent variables included age, gender, race, income, sense of preparedness for the future, isolation, and the number of illnesses. Multinomial logistic regression was conducted.

Results: Two-thirds of respondents (66%) had completed advance directives. Of those with advance directives, 76% had shared their advance directives with their loved ones or health care providers. In other words, 24% did not share their advance directives with anyone. A greater number of illnesses (OR=1.15, p=0.026) and a better sense of preparedness for the future (OR=1.47, p=0.001) increased the odds of sharing advance directives. 

Conclusions and Implications: The findings suggest that people with more illnesses are more likely to share their advance directives. This is probably because people have more opportunities to talk about their preferred treatment with their families and health care providers when they are sick. This implies the importance of encouraging people to talk about their treatment preferences because that would lead them to share their advance directives with others. Another finding is that people who think they have done good preparation for their senior years are more likely to have shared their advance directives with others. Because the study design was cross-sectional, which cannot establish causality, it is unknown if people who want to be better-prepared for the future are motivated to share their advance directives or if people feel prepared for the future because they have shared their advance directives with others. Either way, sharing advance directives is an essential part of preparation for the future because having a person’s treatment preferences known to his/her loved ones or health care providers can help them make decisions in case he/she becomes incapacitated to do so. This information can help social workers facilitate conversations regarding advanced directives in clinical settings.