Later-Life Friendship in Advance Care Planning: Variation by Marital Status and Gender

Friendship is an understudied social context in research on advance care planning (ACP). Using data from the Health and Retirement Study (2018-2020), we examine the associations between the quality and quantity of friendships and older adults' engagement in advance directives (AD) and end-of-life (EOL) discussions. Multivariable logistic regressions show that having any friends is associated with greater odds of AD and EOL discussions. Number of close friends and emotional support are positively associated with AD only. Marital status and gender, both independently and jointly, moderate the associations between friendship predictors and ACP. The positive association between emotional support from friends and EOL discussions is more pronounced among never married men, compared to both married individuals and never married women. These findings highlight friendship as a salient social context associated with ACP engagement, particularly among never married men.