Zahra Rahemi, Juanita-Dawne Bacsu, Delaram Sirizi, Katelyn Hummel, Meisam Omidi, Preeti Zanwar, Matthew Lee Smith, Swann Arp Adams
BACKGROUND: Advance care planning (ACP) is important for older adults experiencing cognitive decline, and social determinants of health (SDoH) may shape engagement. PURPOSE: To evaluate cognitive and social-contextual differences in ACP among older adults. METHODS: Using 2018 Health and Retirement Study data, we evaluated ACP completion, defined as a living will (LW), durable power of attorney for health care, or both, across cognitive status groups and tested SDoH moderation. RESULTS: Individuals with dementia or impaired cognition had lower ACP completion than those with normal cognition. Education and neighborhood support moderated cognition-ACP associations. Among less educated individuals, dementia was associated with lower odds of LW completion. Lower neighborhood support was associated with lower odds of LW completion, whereas higher support was associated with greater odds of reporting at least one ACP measure. CONCLUSION: SDoH shape ACP during cognitive decline. Nurses should prioritize early, equitable ACP discussions to improve end-of-life care quality.