Adult Children as Informants About Parent’s Psychosocial Preferences

Abstract: Utilizing data from 80 adult children-older parent dyads, this study examined the degree to which adult children could predict the psychosocial preferences of their older parents. Overall, children demonstrated good knowledge about parent preferences, although there was wide variability within the sample and across preference domains. Children underestimated how important parents considered continued enrichment and personal growth. Knowledge was associated with parents' functional status and mood. Parent, but not child, perceptions of family flexibility and cohesion were related to children's knowledge. Findings suggest that family life education and intervention programs need to address contextual factors as a means to improve intergenerational knowledge and enhance the likelihood that parent preferences are considered in care planning. Key Words: adult children, family gerontology, intergenerational relations, psychosocial preferences, long-term care planning. When older adults face decisions about housing, finances, or medical care, they often turn to their adult children for guidance. And if older parents cannot express their own preferences because of a physical or cognitive impairment, adult children may be required to act as surrogate decision makers by articulating their parent's preferences. Many state laws have codified the role of adult children as surrogate decision makers (American Bar Association, 2004), reflecting the belief that family members know each other well or are likely to act in each other's best interests. Recent research suggests, however, that family members may have inaccurate beliefs about the care and life preferences of their older adult relatives. For instance, family members were inaccurate when estimating older adults' medical treatment preferences (Roberto, 1999), housing preferences (Mattimore et al., 1997), and interest in research participation (Muncie, Magaziner, Hebel, & Warren, 1997). The current study extends previous work by examining an additional domain surrogates may need to know-psychosocial preferences. Psychosocial preferences are personal affinities that guide the selection of experiences and environments. These preferences are manifested in the choices people make during the hour-by-hour passing of each day. As examples, people have preferences regarding their daily routine, environmental features such as decor, leisure pursuits, foods that are enjoyed (or avoided), and social relationships that are valued (or avoided). Paying attention to psychosocial preferences makes it more likely that older adults will have the kind of life they want. Indeed, efforts to individualize care in nursing homes, assisted living facilities, and community care emerged from the belief that assessment and accommodation of older adults' preferences can influence quality of life (Ross, Steward, & Sinacore, 1993). Because adult children are often asked to guide care that could incorporate preferences, it is important for children to know the psychosocial priorities of their parents. Yet, it is unknown whether adult children actually know this information. The purpose of the current study was to document how well adult children know their parent's psychosocial preferences. Specifically, we examined the degree of accuracy with which adult children predicted the psychosocial preferences of their older parents, and we also identified individual- and family-level characteristics associated with children's accuracy. Potential Factors That Influence a Child's Knowledge of Parent Preferences We consider four sets of factors that might be related to childrens' knowledge preferences: characteristics of the preferences themselves, characteristics of children, characteristics of parents, and characteristics of a family. Characteristics of preferences. Some psychosocial preferences are easily observed (mother gets up every morning at 7 a. …