退休后展望：关于退休个人正式终老计划的模式和预测[外文翻译]

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 individualsabstract： 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 amo

2、ng 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 educated p

3、ersons, 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 should fa

4、cilitate 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；retirementintroductionthe

5、 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 serious psy

6、chological, 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 of patient

7、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 care and the

8、 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).end-of-life

9、 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 assure the usag

10、e 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 for enhancing t

11、he 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 writing, their pref

12、erences 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 are unable t

13、o 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 individuals and familie

14、s 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 written wills

15、(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 the oldest-old (

16、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 indicates that per

17、haps 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 is, we do not

18、 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 individualshealth care providers, lawyers, and financial planners, etc. since there is evidence (brock and foley 199

19、8; 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 estate planning. in

20、 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 assets through j

21、oint 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 specific planning strat

22、egies. 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

23、or complementary planning behaviors?literature and backgroundend-of-life financial preparationsend-of-life financial preparations are most often conceived as estate planning, which has the purpose of carrying out ones intentions of disposing of assets and property and for taking care of family membe

24、rs after ones death (edwards 1991; goebel et al. 2003).oconnor (1996) provided a systematic review of early empirical research on how elders handle their estates. early studies primarily focused on property transfer preferences, characteristics, and motives of those with and without wills, as well a

25、s inheritance and disinheritance patterns. most of the body of research has focused on understanding the direction, timing, and motivation behind intergenerational resource transfers (cox 1987; cox and rank 1992; dunn and phillips 1997; hayhoe and stevenson 2007; koh and macdonald 2006; mcgarry and

26、schoeni 1995, 1997; macdonald and koh 2003). other studies have explained purposes of having a will beyond the distribution of financial assets. rossi and rossi (1990) studied wills and inheritances in the context of family relationships and identified wills as the primary method of handling the tra

27、nsfer not only of valuable financial items, but also of personal possessions in order to manage family relationships after death. stum (2000) examined non-titled property transfers, arguing that inheritance is not simply an economic or legal issue, but one with complex emotional and family relations

28、hip dimensions. schwartz (1993) also explored the legal and family influences on having a will, arguing that wills are also an expression of individualism, and a reflection ofthe individuals relationship with family and community at the time of writing the will. a study by rosenfeld (1992) argues th

29、at due to changing demographics, wills increasingly are tools for designating guardians of grandchildren who are in their custody, or designating care givers for older dependent children. these studies provide insights into how financial wills can work as a multi-function tool for post-death resourc

30、e allocations. studies have examined factors that influence the adoption of a financial will. consistent positive determinants of possession of a will were greater education (goetting and martin2001; lee 2000; oconnor 1996; rossi and rossi 1990; simon et al. 1982), larger estate size (goetting and m

31、artin 2001; lee 2000; oconnor 1996; simon et al. 1982), older age(lee 2000; rossi and rossi 1990; simon et al. 1982), higher household income (oconnor1996; rossi and rossi 1990; simon et al. 1982), and being white (goetting and martin2001; lee 2000; oconnor 1996). other factors such as marital statu

32、s, gender, presence of children in the household, and health status have been found to have inconsistent effects across various studies. palmer et al. (2005) explored what life events appeared to precipitate writing a will among adults. using data from the health and retirement survey(hrs) they foun

33、d that becoming a widow, being diagnosed with cancer, retiring, and having a positive change in assets are significantly related to adoption of a financial will. eol health preparationshealth-related eol preparations have received increased attention from researchers and policy makers in part due to

34、 the growth in hospice care and other social movements that encourage greater patient autonomy in making eol medical care decisions (ott 1999).health-related formal preparation typically comprises two behaviors: completion of a living will and the appointment of dpahc. studies have shown that few pa

35、tients actually possess living wills or dpahcs or have spoken with their physicians about these issues (ott 1999). while the patient self-determination act of 1990 requires hospital to ask about advance directives and provide information on hospital practices, no such requirement is placed on physic

36、ians. some studies probed the reasons for not planning (high 1993; sachs et al. 1992; stelter et al. 1992). high (1993) found individuals feel they can rely on others,particularly family members, to make decisions for them if they are unable to do so. other reasons identified include do not see an u

37、rgent need to do so (stelter et al. 1992), and procrastination (sachs et al. 1992).a number of studies have examined the factors that predict the likelihood of advance directives completion. most of them have focused on the role of socio-demographic and health factors as predictors. a study based on

38、 analysis of medical records from the program for all inclusive care of elderly (pace) found that african american patients were significantly less likely than white patients to complete a dpahc (eleazer et al. 1996).other studies show that individuals with higher levels of educational attainment ar

39、e more likely to complete an advance directive (high 1993; hopp 2000; stelter et al. 1992).advance directives are more prevalent among persons in older age groups compared with younger age groups (elpern et al. 1993; levin et al. 1999), and among those with poorer self-reported health status compare

40、d with better health status (elpern et al. 1993). carr and khodyakov (2007) found that, consistent with the patient self-determination act, recent hospitalizations motivated advance directives. few studies have examined the role of family structure on the likelihood of completing advance directives.

41、 while elpern et al. (1993) found that marital status had no significant effect on the likelihood of completing advance directives, hopp (2000) found that among individuals with living children, those who were not married were significantly more likely than were married individuals to have a living

42、will and dpahc and more likely to report having informal discussions of health care preferences. carr and khodyakov (2007) found that formerly married persons and thechildless were less likely to have formal eol plans than their currently married and with children counterparts. family structure need

43、s further examination as a predictor of eol planning (schaber and stum 2007), to test whether persons who are married or who had living children might bypass an advance directive because they trust their family members to make decisions for them or whether they are more likely to have advance direct

44、ives since they do not want to leave burdens on their family members.summaryresearchers and the public press have regularly encouraged families with elderly members to have conversations about death, health care preferences, and inheritance when appropriate, in order to spare the emotional and finan

45、cial strains at the end of the time ( delgadillo et al. 2004; mcleod 2000; pulliam 1999; stum 2000 ). although discussions are perceived as informal preparations and lack legal power, they are the most convenient tools to communicate eol wishes and even to complement formal planning tools. indeed, a

46、 greater number engage in informal discussions with family members concerning healthcare preferences, in contrast to only a small percentage of people who formally adopt eol health planning (i.e., living will or dpahc) (elpern et al. 1993). yet it is the legal documents that carry weight in court de

47、cisions when family members may disagree on what was said to them about eol wishes or when disagreement arises about the disposition of family assets. legal wills specify the distribution of assets after death and legal eol documents specify ones care prior to death, with implications for asset use.

48、 although financial and health care eol wishes can be thought of as complementary decisions, prior research has treated these as largely two separate decisions rather than approaching each ascomponents of integrated eol planning. this study explores the integration of eol planning, focusing on finan

49、cial and health-related preparations. it explores whether there is evidence that individuals engage in financial and health care eol planning as two distinct planning activities or as components of an integrated eol planning strategy. source: yung-ting su，j fam econ iss，2008，p654673译文：退休后展望：关于退休个人正式

50、终老计划的模式和预测摘要：这项研究使用的是2004年威斯康星的纵向研究，目的是为了研究退休年龄个人的正式终老计划策略模式和预测，研究终老健康计划和财务计划是否是高度相关联的行为。运用逻辑回归和多元逻辑回归分析，结果表明，终老健康计划与财务计划是相结合的。女性，高学历者，以及那些拥有较高净资产的人，更可能有全面的终老计划，同时包括终老的健康计划和终老的财务计划。有人建议，政策制定者，健康及金融专业人士和教育工作者关注缺乏终老健康计划所带来的结果，他们应该将终老健康计划和终老财务计划结合在一起，特别是对那些没有这些计划又面临较高风险的个人。关键词：预前指示；决策；终老；健康和财务规划行为；退休介绍

51、在过去的一个世纪，死的本性和原因发生了变化。死的主要原因现在是慢性疾病或者是那些不能治愈仍持续的疾病。（罗森伯格等人，1996年）新的医疗技术，延长了患病的和垂死的生命，但在这个漫长的过程中，对于病人个人或家庭来说往往会有严重的心理，生理和经济上的问题。（布洛克和福利1998年；原野和卡塞尔1997年）对于临终病人，生命的最后阶段可能会烙下疼痛、残疾、脱离自己的家庭和社区，同时缺少病人应享有的自主权。与此同时，死亡过程对家庭成员会有严重影响，病人可能会在被照顾活动中遭受身体上和精神上的压力。由于病人没有经济收入和附加福利，造成经济的大量消耗，包括卫生保健和长期护理和住院。（范和齐克2004年，

52、2006年；史特姆 2001；沃肖斯基2000）。经济，心理和生理的痛苦伴随着死亡的过程，可能会对那些已做好准备终老的个人和家庭影响少点（伊曼纽尔1996）。作为促进个人处理死后财产转让问题，终老财务计划得到很好建立和广泛接纳。很少有终老健康相关的工具的建立，如1990年患者的自我测定法，这个保证了预先指示的使用和利用（奥特1999年），同时临终关怀运动促进了终老治疗（国家临终关怀组织1995年；全国缓和关怀组织2001年）。医疗事前指示已经开发作为加强个别病人的权利的机制，进一步明确了医疗护理病人的偏好，保护了患者和在护理终老选择上免受代理决策者的法律责任（伊曼纽尔等人2000年）。比如，生

53、前遗嘱让人们以书面的形式明确生活方式，当他们不再能够清晰地表达他们的想法的时候，他们喜欢的医疗照顾依然能够进行。卫生护理上持久耐用的法律权利是一个法律性文件，当病人不能够自己决策时，允许指定的个人替他做出医疗决定。此外，政府机构和卫生专业人员鼓励他们做好心理准备，如与家人讨论关于卫生保健倾向，个人信念，价值和愿望喜好问题（戈贝尔和渴望1994年）。然而，个人和家庭对终老财务和死后资源分配有长期计划，其中很少一部分对健康终老相关的问题和即将要死的问题有规划。最近研究表明，大概有66%超过70岁的美国老年人有书面遗嘱（戈廷和马丁2001年；李2000年）。与此相反，研究报告了一个更低的数据，虽然在

54、增加，大多数的成年人只有预先指示。早些的研究报道了完成率从4%到20%的变化（霍弗勒1997年）。最近的一个研究运用了1995年的资产和卫生动态波，其中老年人显示有37%的样本有预先指示，这表明比过去略有增加（霍普2000年）。哈恩（2003年）报道了一个关于健康维护组织1999个成员的研究发现，三分之一的65岁患者或者年纪更大的人设有预先指令。这表明，在立法机构和健康促进方面，对于变化会有很多不同的回答。然而财务计划和卫生保健计划已经分别进行调查（奥康纳1996年；奥特1999年），老年人是否和如何整合这两个方面的终老规划。那是，我们不知道是否个人趋向于考虑金融和医疗保健计划作为一个共同体或

55、做为完全独立的行动。如果是后者，可能是从不同的个人中得到意见-健康护理提供者，律师，金融规划师等。由于证据显示，终老期间没有医疗保健计划，将会对家庭的经济福利或遗赠造成严重的经济后果，终老健康计划能够被认为是一个合法的财产规划的组成部分。换句话说，终老健康计划和财务计划是综合终老计划相辅相成的两个方面（席尔瓦2004，a，b）。这个研究被终老财务计划的一个补充特性所鼓舞（将有一个财务准备，可撤消信任，以及安排的性质，通过共同所有权准仪或指定受益人的资产），以及与健康相关的准备工作（一份健康护理永久授权书，生前遗嘱）。这项研究的目的是为了记录中年人所接受终老计划策略和识别影响特殊计划策略的可能性

56、的因素。这篇文章研究的问题是（1）什么是终老计划策略采取的模式（2）终老计划策略的决定性因素是什么？（3）终老财务计划和终老健康计划的之间的关系是什么（4）终老计划的两部分是独立的还是相互补充的行为？文献和背景 终老财务计划终老财务准备经常被看做房地产（不动产）规划，它的目的是执行财产所有权和他死后能够照顾家庭成员（爱德华兹1991年；戈贝尔等人2003年）。奥康纳（1996）提供了一个早期的实证研究关于如何系统地回顾长者处理其房屋。早期研究主要集中在财产转让喜好上，特点，以及那些有遗嘱没遗嘱的动机，与继承和剥夺继承权的模式。该研究机构主要集中于了解方向，时机和动机背后的代际资源转移（考克斯1

57、987年；考克斯和排名1992年；邓恩和菲利普斯1997年；海霍和史蒂文森2007年；孔和麦当劳2006年；麦加里和少励1995年，1997年；麦克唐纳和孔2003年）。其他研究详细阐述了其超越了金融资产分布遗嘱的目的。罗西和罗西（1990）研究遗嘱及家庭中继承关系，为了在死后处理好家庭关系，他们要以先前的方式明确有价值的财务同时也要明确好个人的所有权问题。斯特姆（2000）研究了无名财产转让，认为继承不是单纯的经济或法律问题，而是复杂的情感和家庭关系问题。施瓦兹（1993）探讨了有关法律和家庭问题对遗嘱的影响，认为遗嘱是个人主义的体现，是反映个人与家庭和社会的关系，体现写作时的意愿。由罗森菲

58、尔德的研究报告认为，由于人口结构改变，遗嘱成为一种工具，用来指定谁照看孙子和那些没有谋生能力的子女。这些研究提供了信息关于财务遗嘱是怎样作为一个死后资源分配的多功能工具。研究检验了影响接受财务遗嘱的因素。组成遗嘱拥有权的积极决定因素就是获得更高的教育（戈廷和马丁2001年，李2000奥康纳1996年，罗西和罗西1990年；西蒙等人1982年），大屋（戈廷和马丁2001年；李2000奥康纳1996年，西蒙等人1982年），年龄（李2000；罗西和罗西1990年；西蒙等人1982年），较高的家庭收入（奥康纳1996年，罗西和罗西1990年；西蒙等人1982年），成为白人（戈廷和马丁2001年，李2000奥康纳1996年）。另外的因素，如婚姻状况，