Advance care planning of U.S. older adults with limited family ties: Evaluating the impacts of partnership trajectories and parental statuses

Planning for end-of-life health care decisions is critical for dying persons and their families. Advance care planning (ACP), which encompasses a living will, durable power of attorney for health care (DPAHC), and conversations about end-of-life preferences, is inherently relational, where older adults rely on family and consider their concerns while carrying out ACP. However, it is unclear how unmarried persons, those who recently lost a partner through death or union dissolution, childless, and kinless persons prepare for end-of-life. We use data from the 2006-2022 waves of the Health and Retirement Study (N = 10,817) to explore how complex romantic partnership histories, parental status, and the intersection of the two affect four subtypes of ACP (advance directives only [formal], informal discussions only [informal], both, or neither), and their distinctive components (living wills, DPAHCs, and discussions). We examine whether these patterns differ by gender, after adjusting for sociodemographic and health covariates. Multivariable analyses show that both recently and long-term widowed persons are most likely to do ACP. Never-married persons are least likely to have living wills. Cohabiting persons resemble married persons. Women are more likely than men to do ACP following divorce or a cohabitation dissolution. Parents are more likely to have informal discussions whereas childless persons are more likely to have living wills. We found limited evidence that relationship trajectory differences were moderated by gender or parental status. Our results reveal the complex ways that family statuses affect end-of-life preparations and can inform end-of-life policies and practices.