Self-perceptions of aging and advance care planning: Longitudinal evidence from the Health and Retirement Study

Advance care planning (ACP) is increasingly conceptualized as a proactive, communication-centered process that supports person-centered care in later life. Although prior research has focused on demographic and clinical predictors, less is known about the psychological factors that shape how individuals engage in planning. Guided by Stereotype Embodiment Theory, this study examined whether self-perceptions of aging (SPA) prospectively predict patterns of ACP engagement.

Data were drawn from the Health and Retirement Study (2008-2014). A lagged longitudinal design linked baseline SPA to ACP engagement four years later among adults aged 65 and older (N = 7,618). ACP was categorized as: both formal (documentation) and informal (discussion) planning, formal-only, informal-only, or neither. Multinomial logistic regression models assessed associations between SPA and ACP patterns, adjusting for sociodemographic and health characteristics. Interaction models tested moderation by sociodemographic and health factors, and exploratory analyses examined transitions into ACP among baseline nonplanners.

More positive baseline SPA was associated with a lower likelihood of engaging in formal-only ACP relative to engaging in both formal and informal ACP. SPA was not significantly associated with informal-only ACP or with no ACP relative to comprehensive planning. Associations between SPA and ACP patterns did not vary across sociodemographic groups, although functional limitations and self-rated health modestly moderated specific contrasts. Among respondents with no prior ACP, SPA did not significantly predict transitions into planning over time.

These findings extend Stereotype Embodiment Theory to future-oriented healthcare planning and highlight SPA as a psychosocial factor associated with comprehensive ACP engagement.