Identifying the Social Determinants of Disparities in Advance Care Planning between White and African-American Older Adults
Advance care planning (ACP), including life-sustaining treatment discussions and advance directives, is widely promoted by the legal and medical professions and is associated with several positive end-of-life quality of care indicators. Numerous studies have found that older African Americans are significantly less likely to engage in ACP than their white counterparts. Several social determinants have been proposed as possible explanations for these disparities, however no clear mechanisms have yet been identified. Recently released data provide an opportunity to test the influence of identified social determinants of ACP using a large, nationally-representative sample of white and African-American older adults. Understanding the underlying reasons why older African Americans in particular are less likely to complete advance directives or engage in end-of-life discussions will contribute of our understanding of the factors that serve as facilitators and/or barriers to ACP and may help to improve outreach and intervention programs targeting this diverse and often marginalized population of older adults.