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

Objectives. We evaluated a model of the process of preparation for future c are 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 a ttitudes (expectations of needing care and negative beliefs about the usefu lness of planning) would mediate the effect of vulnerability (age, ADL/IADL deficits) and resources (socioeconomic status, social network) on preparat ion activities. Methods. The Preparation for Future Care Needs Measure was used to assess t wo attitudes toward preparation (Cronbach's alpha range:.66-.86), four plan ning processes (Cronbach's alpha range:.75-.86), and the content of plannin g for future care needs. In addition, demographic variables, social network , and ADL/IADL limitations were assessed. Using path analysis, the model wa s first developed on a West German sample (n = 280), and then validated on an East German sample (n = 294). Results. The best-fitting path models suggested that more concrete preparat ion 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 e xpectations of needing care in the future and several preparation activitie s, especially becoming aware and gathering information. Negative beliefs ab out the usefulness of planning inhibited gathering information and concrete planning. Discussion. The results suggest that preparation for future care needs may be conceptualized as a successive process. Some individuals, however, may s kip steps in the preparation process. For example, relatives may offer to p rovide care before the older adult has to decide among her or his options.