Do older adults with Alzheimer's disease engage in estate planning and advance care planning preparation?

Abstract

Our findings suggest that a diagnosis of AD is associated with more engagement in ACP for individuals and their families, but important barriers exist for people with fewer resources.

Attitudes toward advance care planning among persons with dementia and their caregivers

“…The present study examined the extent of ACP among a well-characterized, racially and geographically diverse sample of 431 study partners of persons with dementia and explored factors that affect decisions about ACP, attitudes towards end-of-life care in dementia, and racial differences in these measures. Overall, high rates of ACP were reported, consistent with recent reports (Choi et al, 2018;Jeznach et al, 2015). There were, however, notable racial differences in attitudes toward ACP between African American and white respondents.…”

“…While a number of prior studies have examined ACP in the context of dementia, studies with larger sample sizes have tended to be retrospective reviews of existing records or study variables (e.g. Choi et al, 2018;Jeznach et al, 2015;Lingler et al, 2008;Tjia et al, 2018), placing limits on the amount of information that can be extracted, whereas studies collecting more detailed information about attitudes towards ACP have tended to be qualitative, with smaller sample sizes (e.g. Hirschman et al, 2008;Moss et al, 2018a;Ryan et al, 2017).…”

“…Although a small number of retrospective studies have suggested that persons with dementia or cognitive impairment may be more likely to engage in some aspects of ACP relative to individuals without memory impairment (Choi et al, 2018;Jeznach et al, 2015), multiple factors may serve as barriers to the initiation of ACP in dementia and challenges to care decisionmaking (e.g. Dening et al, 2011;Hirschman et al, 2008;Jones et al, 2016;Noh and Kwak, 2018), including avoidance of the topic, need for education regarding ACP, and racial minority status, among others.…”

Estate planning among older Americans: The moderating role of race and ethnicity

“…Sociodemographic characteristics were included in the analyses as covariates. Selection of these variables was based on a number of well‐established findings on the factors associated with estate planning (e.g., Bernheim, ; Choi et al, ; Cox & Stark, ; DiRusso, ; Fitzgerald, ; Goetting & Martin, ; James, ; Kao et al, ; Lockwood, ; Palmer et al, ; Su, ). These factors included age, sex (female, male), marital status (married or partnered, separated or divorced, widowed, never married), the presence of living children (1 = yes, 0 = no), years of educational attainment, employment status (full‐time working, part‐time working or partially retired, retired, unemployed, disabled, or not in labor force), religion (Protestant, Catholic, Jewish or other, none), total household income, total non‐housing wealth, the net value of primary residence house, having long‐term care insurance or life insurance (1 = yes, 0 = no), and self‐rated health conditions.…”

“…Using the HRS data, previous studies have explored factors affecting charitable estate planning (James, ), the effect of family traditions on bequest behaviors (Cox & Stark, ; Rossi & Rossi, ), and the association between financial assets and bequest expectations (Choi & Wilmarth, ) among households with older adults. Across such studies, people who have a valid will have been characterized as being older, being White, being female, and having a higher educational attainment and socioeconomic status (Choi et al, ; Cox & Stark, ; James, ; Kao, Hong, & Widdows, ; Palmer et al, ; Su, ). Thus, it appears that marginalized and underrepresented individuals of lower socioeconomic backgrounds are less likely to have estate planning documents.…”