End-of-life experience patterns among older adults and their association with pain near death: A population-based study

Abstract

Background:

The end-of-life experience is a multidimensional concept that involves multiple domains, such as physical, social, caregiving, and environmental aspects, but previous studies have examined only individual factors. Analyzing the heterogeneity of older adults’ end-of-life experiences via comprehensive evaluation indicators can enhance understanding of the end-of-life process and inform the development of personalized care strategies.

Aim:

To identify end-of-life experience patterns among older adults via comprehensive evaluation indicators.

Design, setting/participants:

In this cross-sectional study, Chinese Longitudinal Healthy Longevity Survey (CLHLS) data were used. Older adults (aged 65 years and older) who died between 2008 and 2018 were selected. Data on the physical condition, family support, caregiving, and place of death of older adults were extracted to perform a latent class analysis to identify end-of-life experience patterns. A multinomial logistic regression was employed to explore the association between demographic characteristics and class membership, and an ordinal logistic regression was used to examine the relationship between class membership and pain near death.

Results:

A total of 15,844 deceased older adults were included in the study. Latent class analysis identified three end-of-life experience patterns: ‘limited companionship–institutional death’ (14.28%), ‘functional disability–family care’ (60.70%), and ‘living well–affordable caregiving’ (25.02%). Females who lived in cities were more likely to belong to the functional disability–family care class. The living well–affordable caregiving class was associated with the lowest level of pain near death.

Conclusions:

Further strategies need to be implemented to address gender and urban‒rural inequities in end-of-life care. It is crucial to prioritize expanding access to community-based healthcare resources and offering comprehensive training for family caregivers.