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The Gerontologist 40:449-457 (2000)
© 2000 The Gerontological Society of America

Preferences for Surrogate Decision Makers, Informal Communication, and Advance Directives Among Community-Dwelling Elders

Results From a National Study

Faith P. Hopp, PhDa

a Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, MI

Correspondence: Faith P. Hopp, PhD, Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, PO Box 130170, Ann Arbor, MI 48113-0170. E-mail: Faith.Hopp{at}

Decision Editor: Vernon L. Greene, PhD

This study, drawing on a nationally representative sample of community-dwelling adults aged 70 and older from the second wave of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, addresses the need for greater information on advance care planning among older adults. Older persons expect to draw on a diverse array of persons to make health care decisions for them when they are unable to do so, including spouses, when available, as well as younger generation members such as children and grandchildren. Completion of advance directives such as living wills and durable powers of attorney for health care was more common among White respondents than among African American respondents, and among high school– and college-educated respondents compared with those with less than a high school education. The results suggest the need to develop interventions aimed at strengthening knowledge and understanding of advance directives, particularly for African Americans and persons with lower levels of educational attainment. They further suggest the need for more research on the factors related to informal communication between older adults and their family members on issues related to advance care planning.

Key Words: Advance directives • End-of-life care • Decision making • Surrogates

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