Preparation for future care needs by West and East German older adults

We evaluated a model of the process of preparation for future care needs. This model predicted that less concrete preparation activities (e.g., becoming aware and gathering information) would predict more concrete ones (e.g., deciding on preferences and making concrete plans), and that attitudes (expectations of needing care and negative beliefs about the usefulness of planning) would mediate the effect of vulnerability (age, ADL/IADL deficits) and resources (socioeconomic status. social network) on preparation activities.

The Preparation for Future Care Needs Measure was used to assess two attitudes toward preparation (Cronbach's a range: .66-.86),. four planning processes (Cronbach's a range: .75-.86), and the content of planning for future care needs. In addition, demographic variables, social network, and ADL/IADL limitations were assessed. Using path analysis, the model was first developed on a West German sample (n = 280), and then validated on an East German sample (n = 294).

The best-fitting path models suggested that more concrete preparation activities were predicted by less concrete ones, but not always in the expected sequence. Gathering information, deciding on preferences, and age predicted concrete planning. Indicators of vulnerability were mediated by expectations of needing care in the future and several preparation activities, especially becoming aware and gathering information. Negative beliefs about the usefulness of planning inhibited gathering information and concrete planning.

The results suggest that preparation for future care needs may be conceptualized as a successive process. Some individuals, however, may skip steps in the preparation process. For example, relatives may offer to provide care before the older adult has to decide among her or his options.