1、本科毕业设计（论文） 外 文 翻 译 原文： Looking Beyond Retirement: Patterns and Predictors of Formal End-of-Life Planning Among Retirement Age Individuals Abstract： this study uses the 2004 wave of the Wisconsin Longitudinal Study to examine the patterns and predictors of formal End-of-Life (EOL) planning strategies
2、 among retirement age individuals and whether EOL health and financial planning are highly correlated planning behaviors. Using logistic regressions and multinomial logistic regressions, findings show that EOL health plans appear to be done in combination with financial plans. Females, higher educat
3、ed persons, and those with higher net worth are more likely to have integrated EOL plans containing both EOL health and EOL financial plans. It is suggested that policy makers, health and financial professionals, and educators concerned about the consequences of the absence of EOL health plans shoul
4、d facilitate the joint planning with finances, especially among those at higher risk of not having such plans (e.g., males, less educated persons, and those who have little net worth). Keywords： Advance directives； Decision making； End-of-Life； Health and financial planning behavior； Retirement Intr
5、oduction The nature and causes of death have shifted over the past century. The leading causes of death are now chronic diseases, or ongoing conditions for which there is no cure (Rosenberg et al.1996). New medical technologies prolong lives of the sick and dying, but the prolonged process often has
6、 serious psychological, physical, and financial consequences not only for the patients but also for the family (Brock and Foley 1998； Field and Cassel 1997). For the dying patients, the final stage of life may be marked by physical pain, disability, isolation from ones family and community, and lack
7、 of patient autonomy. Meanwhile, the dying process has critical impacts on the family members, who may suffer physical and psychological strains from caregiving activities, and the depletion of economic resources due to the loss of the disabled persons earnings and fringe benefits, including health
8、care and the costs of long-term care or hospitalization (Fan and Zick 2004,2006； Stum 2001； Warshawsky et al. 2000). The economic, psychological, and physical strains that accompany the dying process may be less severe for individuals and families who prepare for the End-of-Life (EOL) (Emanuel 1996)
9、. End-of-Life financial planning (i.e., estate planning) is well established and widely accepted as facilitating individuals dealing with post-death assets transfer issues. Lesswell established are EOL health-related tools such as those provisions of the 1990 Patient Self-Determination Act, which as
10、sure the usage and utilization of the advance directives(Ott 1999), and the Hospice movement, which promotes palliative care at the EOL(National Hospice Organization 1995； National Hospice and Palliative Care Organization2001). Advance directives for health care have been developed as a mechanism fo
11、r enhancing the rights of individual patients, clarifying patient preference for medical care, and protecting both patients and surrogate decision makers from legal liability for health care decisions at the EOL (Emanuel et al. 2000). For example, the Living Will allows persons to specify, in writin
12、g, their preferences for medical care to be followed when they themselves are no longer able to articulate their own preferences.1 The Durable Power of Attorney for Health Care (DPAHC) is a legal document that allows a person to designate another individual to make medical decisions for them if they
13、 are unable to do so. Furthermore, psychological preparations such as in-depth discussions with family members on preferences of health care treatments, personal beliefs, values and desires, have been encouraged by government agencies and health professionals (Goebel and Crave 1994). While individua
14、ls and families have long planned for the EOL financially and for the resource distribution after death, many fewer individuals have planned for health-related issues at the EOL and the consequences of approaching death. Recent studies show that about 66% of U.S. older adults over the age of 70 had
15、written wills (Goetting and Martin 2001； Lee 2000). In contrast, studies report a lower, though growing, proportion of adults with advance directives. Earlier studies report from 4 to 20% of the completion rate (Hoefler 1997). A more recent study using 1995 wave of Asset and Health Dynamics among th
16、e oldest-old (AHEAD) shows that 37% of the sample had advance directives, indicating a slight increase from the past (Hopp 2000). Hahn (2003) reports a 1999 study of members of a health maintenance organization found that one-third of patients aged 65years or older have an advance directive. It indi
17、cates that perhaps there are cohort differences in response to changes in legislature and health motivations. While financial planning and health care planning have been separately investigated (OConner 1996； Ott1999), whether and how older adults integrate both aspects of EOL planning has not. That
18、 is, we do not know whether individuals tend to consider financial and health care planning jointly or as entirely separate actions. The latter is likely if advice is obtained from separate sets of individuals health care providers, lawyers, and financial planners, etc. Since there is evidence (Broc
19、k and Foley 1998； Chambers et al. 1994； Fan and Zick 2004； Field and Cassel 1997) showing that not having health care plans for EOL will lead to severe financial consequences for a familys economic well-being or impacts on bequests, EOL health planning can be viewed as a legitimate component of esta
20、te planning. In other words, EOL health and financial planning are two complementary aspects of comprehensive EOL planning (Silva 2004a, b). This study is motivated by the complementary nature of EOL financial preparations (having a financial will, a revocable trust, and an arrangement to transfer a
21、ssets through joint ownership or designated beneficiaries), and health-related preparations (having a DPAHC, a Living Will). The purpose of this study is to document the EOL planning strategies adopted by midlife adults and to identify the factors that influence the likelihood of engaging in specifi
22、c planning strategies. The research questions are: (1)What are the patterns of EOL planning strategies adopted? (2) What are the determinants of EOL planning strategies? (3) What is the relationship between EOL financial planning and EOL health planning? (4) Do the two aspects of EOL planning appear to be distinct or
