Racial and Ethnic Disparities in Advance Care Planning: Assessing the Role of Subjective Life Expectancy.

OBJECTIVES: Persistent race disparities in advance care planning (ACP) are troubling, given Black and Hispanic older adults' elevated risk of disease, some dementias, and receipt of care that may not align with their preferences. A potentially important yet underexplored explanation for these disparities is subjective life expectancy (SLE) or beliefs about one's future survival that may impel or impede ACP. METHODS: Data are from the Health and Retirement Study (n = 8,912). We examined the extent to which perceived chances of living another 10 years are associated with 3 components of ACP (living will, durable power of attorney for health care [DPAHC], and informal discussions). We used multilevel logistic regression models to evaluate the extent to which SLE mediates the association between race and ACP, adjusting for demographic, socioeconomic, psychosocial, and health characteristics. RESULTS: Black and Hispanic older adults have significantly lower rates of ACP relative to Whites. These disparities persist even when SLE is controlled. Blacks report especially optimistic whereas Hispanics report pessimistic survival expectations, although these differences do not explain racial disparities in ACP. SLE has direct effects on ACP, such that persons who report an "uncertain" SLE are less likely to have a living will or a DPAHC, whereas those who perceive a 50% chance of survival have significantly greater odds of discussions, relative to those who perceive a 0% chance of survival. DISCUSSION: Doctor-patient conversations about the likely course of one's illness may inform patients' knowledge of their SLE, which may motivate timely ACP.

Impact of the COVID-19 pandemic on community services for homebound older adults in New York City.

The ongoing COVID-19 pandemic has affected multiple aspects of society. Based on data from a community program, this study examined how the pandemic influenced community services for homebound older adults and whether those services could be delivered via internet-based information and communications technology. Using mixed methods, we collected quantitative data from client profiles and service documents and qualitative data from phone interviews with program staff members and clients. The quantitative results show that during the pandemic, more services were provided for the physical well-being of homebound older adults than for their psychological and home environment needs. Service duration during the pandemic was significantly longer than prior to the pandemic. The qualitative data indicate that the pandemic has influenced inputs, activities and outcomes of the program. The program staff members and clients expressed concerns about delivering services online. Based on the findings, we provide suggestions for future practice and policy.

Racial Disparities of Possessing Healthcare Power Attorney and Living Will Among Older Americans: Do SES and Health Matter?

CONTEXT: Most previous studies considered advance directives (AD) as one outcome, which conceals possible variations of individuals' decisions on two AD documents-living will (LW) and durable power of attorney for health care (PA). OBJECTIVES: To address this issue, this study examined how completions of PA and LW are associated with race, and whether SES and health can partially explain the racial disparities of AD possession. METHODS: The sample included 9902 older adults from the 2016 wave of the Health and Retirement Study. AD completion was coded as a four-category variable, including no PA or LW, no PA, no LW, and both PA and LW. Race was categorized as non-Hispanic white, non-Hispanic black, Hispanic, and Asian or Native American. Socioeconomic status (SES) was measured by education and household wealth. Health was indicated by chronic conditions and functional limitations. Multinomial logistic regression models were used to examine the racial effects of AD possession and the effects of SES and health conditions. RESULTS: Older adults who only have PA or only have LW significantly differed in racial identity, SES and health. The regression results show that being a racial minority was associated with a lower likelihood to have both ADs and only PA. SES partially buffered racial disparities in AD possession, while the moderation of health was not consistently significant. DISCUSSION: The findings highlight the importance of examining the completions of two AD documents and indicate the necessity of developing distinct and concrete strategies to promote the completion of PA and LW.