Objective Dyadic perspective is scarce in existing advance directive (AD) literature. Particularly, the significance of one’s own and/or one’s partner’s cognitive function on AD remains unknown. This study investigates the relationship of cognitive function and other factors with AD completion within the spousal context. Method Data from the Health and Retirement Study (2014–2015) were used. Older heterosexual couples (age ≥65) married for 10+ years were asked if they had a living will and/or appointed a durable power of attorney for health care (DPAHC). Structural equation models examined the actor and partner effects of sociodemographic, health, and couple-level characteristics on wife’s and husband’s AD, respectively. Results Moderate spousal interdependence was observed in living will (kappa coefficient, κ = .60) and DPAHC (κ = .53). Older age and higher education were related to both spouses having AD. Less household wealth and being racial/ethnic minority were associated with a lower probability of having AD. Notable gender contrasts in actor and partner effects were found. Wife’s higher level of cognitive function was associated with husband’s AD completion. Contrarily, husband’s lower level of cognitive function was associated with wife’s AD completion. Retirement status had primarily actor effects for both husbands and wives. More chronic conditions were linked to husband’s AD completion. Discussion The spousal interdependence of AD warrants practitioner efforts to facilitate family-oriented end-of-life planning. Wives and husbands may have different thoughts regarding their spouse’s cognitive capacity to surrogate. Facilitating couple-based discussions may be a feasible approach to promote engagement with AD among older adults.

中文翻译：

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美国老年夫妇的预先指令完成：关于认知功能和其他因素的作用的二元视角

现有的预先指示 (AD) 文献中缺乏客观的二元视角。特别是，自己和/或伴侣的认知功能对 AD 的重要性仍然未知。本研究调查了配偶背景下认知功能和其他因素与 AD 完成的关系。使用来自健康和退休研究（2014-2015）的方法数据。询问已婚 10 年以上的老年异性恋夫妇（年龄≥65 岁）是否有生前遗嘱和/或是否有持久的医疗保健授权书（DPAHC）。结构方程模型分别检验了社会人口、健康和夫妻层面特征对妻子和丈夫 AD 的影响。结果 在生活意愿（kappa 系数，κ = .60）和 DPAHC（κ = .53）中观察到中度的配偶相互依赖。年龄较大和受教育程度较高与夫妻双方都患有 AD。较少的家庭财富和少数族裔与患 AD 的可能性较低有关。发现了演员和伴侣效应的显着性别对比。妻子较高水平的认知功能与丈夫的 AD 完成有关。相反，丈夫的认知功能水平较低与妻子的 AD 完成有关。退休状态主要对丈夫和妻子产生影响。更多的慢性病与丈夫的 AD 完成有关。讨论 AD 的配偶相互依赖需要从业者努力促进以家庭为导向的临终计划。对于配偶代孕的认知能力，妻子和丈夫可能有不同的想法。