"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 ( = 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.