Expanding the Scope of Advance Care Planning: Investigating the Relationship between End-of-Life Planning and Bereaved Partners’ Mental Health

Abstract

End-of-life is as salient a time for dying individuals as it is for their loved ones, especially those serving as surrogate decisionmakers or caregivers. There is extensive research on the association between advance care planning and EOL quality, but a gap persists in our understanding of how ACP is associated with family health outcomes. I used high-quality, nationally representative data from biennial waves of the Health and Retirement Study, from 2000 to 2020, to investigate the association between a decedent’s use of ACP and their spouse or partner’s depression outcomes post-bereavement and any racial/ethnic or gender differences in these outcomes (n=3,555). I estimated ordinary least squares and logistic regression models to predict partners’ CES-D scores and odds ratios of experiencing clinical depression with adjustment for sociodemographic, EOL, and health characteristics. Having a partner who completed any form of EOLP is not associated with depression outcomes post-bereavement, but decedents’ completion of formal ACP — including creating a living will and/or appointing a durable power of attorney for healthcare — was associated with lower spousal CES-D scores compared to having informal-only or combined ACP, as well as lower odds of clinical depression compared to informal-only ACP. Decedents’ use of only informal ACP was associated with higher CES-D scores and odds of depression among their bereaved partners compared to formal, combined, and no ACP. These findings support calls for more widespread usage of formal ACP, greater attention toward bereaved family, and an expansion in evaluations of ACP’s effectiveness to include bereaved family health outcomes.