title: End-of-life planning in a family context: does relationship quality affect whether (and with whom) older adults plan?
abstract: OBJECTIVE
  Medical professionals typically approach advance care planning (ACP) as an individual-level activity, yet family members also may play an integral role in making decisions about older adults' end-of-life care. We evaluate the effects of marital satisfaction and parent-child relationship quality on older adults' use of advance directives (i.e., living will and durable power of attorney for health care [DPAHC] appointments) and end-of-life discussions.
  
  
  METHODS
  Using multinomial logistic regression models and data from a sample of 1,883 older adults in the Wisconsin Longitudinal Study, we estimated the effects of marital satisfaction, emotional support and criticism from children, other social support, demographic characteristics, and health on general ACP (i.e., advance directive only, discussions only, both, or neither) and specific DPAHC appointments.
  
  
  RESULTS
  Parents with problematic parent-child relationships were less likely to complete ACP, and marital satisfaction was positively associated with completion of both advance directives and discussions. Happily married persons were more likely to appoint their spouse as DPAHC, whereas persons who received ample emotional support from children were mostly likely to appoint an adult child.
  
  
  CONCLUSIONS
  Family dynamics affect ACP in complex ways and should be considered in patient-provider discussions of end-of-life care.
authors.affiliation: Department of Sociology, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey 08901, USA. carrds@rutgers.edu
authors.forename: Deborah
authors.initials: D
authors.lastname: Carr
authors.forename: Sara M
authors.initials: SM
authors.lastname: Moorman
authors.forename: Kathrin
authors.initials: K
authors.lastname: Boerner
mesh_terms: D032721:Adult Children / Q000523:psychology*; D032722:Advance Care Planning / Q000706:statistics & numerical data*; D016223:Advance Directives / Q000523:psychology; D000368:Aged; D015331:Cohort Studies; D005195:Family Relations; D005260:Female; D006801:Humans; D016224:Living Wills / Q000523:psychology; D008137:Longitudinal Studies; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010287:Parent-Child Relations; D010549:Personal Satisfaction; D012944:Social Support; D018454:Spouses / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Advance care planning; End of life; Marital relations; Parent–child relationships.