Background While numerous cross-sectional studies reported that advance directive (AD) completion varies significantly by age, gender, and education level, little is known about the factors that prompt AD completion over time. This study aims to identify the social, regional, and health characteristics associated with AD adoption over four years in a population-based sample of adults aged 55+ in Switzerland.
Methods We used data from wave 6 (2015) and wave 8 (2019/2020) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in Switzerland. AD adoption was defined as not having completed ADs in wave 6 while having completed ADs four years later. We used probit regression models to examine the associations between key social, regional, health characteristics and their change between wave 6 and wave 8 and AD adoption over the same period.
Results In wave 6, 842 respondents reported not having completed ADs. Among them, 269 (30.9%) reported the completion of ADs in wave 8. We found that older age (being 65–74 or 75+ vs 55–64 years) was the only social characteristic significantly and positively associated with AD adoption. Respondents living in French- and Italian-speaking Switzerland were significantly less likely to adopt ADs than those in German-speaking Switzerland. Self-rated health, having limitations with activities, and frailty status in wave 6 were not significantly associated with AD adoption between waves 6 and 8. Consistently, a change in partnership status, in self-rated health, in limitations with activities, in frailty status, and the occurrence of a major health event (stroke, cancer, heart attack) between wave 6 and wave 8 were not associated with AD adoption over the same period.
Conclusion Older age and living in a German-speaking region seem to be more critical determinants of AD adoption than health status or change in health status in older adults in Switzerland.
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