Public Release: 

Older married couples and advance directives

American Geriatrics Society

Advance directives (ADs) are legal documents you can use to state in advance what medical treatments you do or do not wish to have under certain circumstances. You also can use an AD to name one or more people to act on your behalf if you are ever unable or uncomfortable making your own healthcare decisions.

Studies have shown that, at the end of life, people who have ADs receive less aggressive life-sustaining treatment and are less likely to be admitted to intensive care units, sometimes because those may not be options an older person wants to pursue. They are also more likely to die at home instead of in a hospital, and they receive hospice care earlier and for longer periods of time.

About 50 percent of people 65 and older in the United States have completed ADs. However, little is known about why some people have them while others do not. Most research treats the decision to complete an AD as an individual choice, but we know little about the roles that spouses and other family members may play in a person's decision to engage in end-of-life planning.

A new study examined the effects spouses had on the decision of older adults to have ADs. The study was published in the Journal of the American Geriatrics Society.

The study's researcher, Catheryn S. Koss, JD, PhD, of the Gerontology Center, University of Kansas, examined information from 2,243 married couples aged 65 and older who had participated in the Health and Retirement Study during 2004-2012.

In the study, Dr. Koss looked at how individual characteristics and characteristics of a person's spouse influenced whether older adults had ADs. These characteristics included:

  • Age
  • Education
  • Poor health
  • Prior hospitalizations and/or outpatient surgeries (those that don't require an overnight hospital stay)
  • Having greater household assets

Among participants in the study, 57 percent of men and 56 percent of women had ADs. Both spouses had ADs in 46 percent of couples and neither had ADs in 33 percent of couples.

Some of the insights the study revealed include:

  • Age (for an individual and his/her spouse) was linked to having an AD for both men and women.
  • Men's education was associated with having their own AD and an AD for their wives.
  • The worse a wife's health, the less likely a man was to have an AD.
  • Hospitalization and/or outpatient surgery for men was associated with having an AD for both spouses.
  • Women with regular healthcare providers were more likely to have an AD, but this did not hold true for men.

The results of this study suggest that having an AD among older married adults is affected both by the characteristics of individuals in a married relationship, as well as their joint experience as a couple. Furthermore, how spouses influence one another's advance care planning seems to differ by gender.


This summary is from "Beyond the Individual: The Interdependence of Advance Directive Completion by Older Married Adults." It appears online ahead of print in the April 2017 issue of the Journal of the American Geriatrics Society. The study author is Catheryn S. Koss, JD, PhD.

About the Health in Aging Foundation

This research summary was developed as a public education tool by the Health in Aging Foundation. The Foundation is a national non-profit established in 1999 by the American Geriatrics Society to bring the knowledge and expertise of geriatrics healthcare professionals to the public. We are committed to ensuring that people are empowered to advocate for high-quality care by providing them with trustworthy information and reliable resources. Last year, we reached nearly 1 million people with our resources through We also help nurture current and future geriatrics leaders by supporting opportunities to attend educational events and increase exposure to principles of excellence on caring for older adults. For more information or to support the Foundation's work, visit

About the Journal of the American Geriatrics Society

Included in more than 9,000 library collections around the world, the Journal of the American Geriatrics Society (JAGS) highlights emerging insights on principles of aging, approaches to older patients, geriatric syndromes, geriatric psychiatry, and geriatric diseases and disorders. First published in 1953, JAGS is now one of the oldest and most impactful publications on gerontology and geriatrics, according to ISI Journal Citation Reports®. Visit for more details.

About the American Geriatrics Society

Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has -- for 75 years -- worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit

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