Objective: We examined whether older adults’ health and well-being during their final year of life predicts end-of-life (EOL) quality of life (QOL) and quality of care (QOC). Methods: Using data from deceased participants (n = 1125) in the 2011–2015 National Health and Aging Trends Study, we performed latent class analysis to identify profiles of health and well-being, and we examined the association between these classes and EOL QOL and QOC. Results: Four classes were identified: healthy/happy (20%), frail/happy (37%), cognitively impaired/moderately distressed (27%), and highly impaired/highly distressed (16%). Persons in the highly impaired/highly distressed class showed a poorer QOL at the EOL, whereas those in the healthy/happy class reported a lower level of QOC at the EOL. Discussion: The benefits of maintaining health and well-being often carry forward to EOL. Older adults with high impairment and distress merit greater attention such as assuring care and advance care plans.
Al-ShahriM. Z.MolinaE. H.OneschukD. (2003). Medication-focused approach to total pain: Poor symptom control, polypharmacy, and adverse reactions. American Journal of Hospice and Palliative Medicine, 20(4), 307-310. doi:10.1177/104990910302000414
2.
AmjadH.SnyderS. H.WolffJ. L.OhE.SamusQ. M. (2019). Before hospice: Symptom burden, dementia, and social participation in the last year of life. Journal of Palliative Medicine, 22(9), 1106-1114. doi:10.1089/jpm.2018.0479
3.
CagleJ. G.BuntingM.KelemenA.LeeJ.TerryD.HarrisR. (2017). Psychosocial needs and interventions for heart failure patients and families receiving palliative care support: A systematic review. Heart Failure Reviews, 22(5), 565-580. doi:10.1007/s10741-017-9596-5
CarrD. (2003). A “Good Death” for whom? Quality of spouse’s death and psychological distress among older widowed persons. Journal of Health and Social Behavior, 44(2), 215-232. doi:10.2307/1519809
6.
CarrD.MoormanS. M. (2009). End-of-life treatment preferences among older adults: An assessment of psychosocial influences. Sociological Forum, 24(4), 754-778. doi:10.1111/j.1573-7861.2009.01135.x
7.
CeleuxG.SoromenhoG. (1996). An entropy criterion for assessing the number of clusters in a mixture model. Journal of Classification, 13(2), 195-212. doi:10.1007/bf01246098
8.
ClarkD. (1999). ‘Total pain’, disciplinary power and the body in the work of Cicely Saunders, 1958–1967. Social Science & Medicine, 49(6), 727-736. doi:10.1016/S0277-9536(99)00098-2
9.
EmanuelE. J.EmanuelL. L. (1998). The promise of a good death. The Lancet, 351, SII21-SII29. doi:10.1016/S0140-6736(98)90329-4
10.
EngelG. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129-136. doi:10.1126/science.847460
11.
FriedL. P.TangenC. M.WalstonJ.NewmanA. B.HirschC.GottdienerJ.SeemanT.TracyR.KopW. J.BurkeG.McBurnieM. A. (2001). Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(3), M146-M157. doi:10.1093/gerona/56.3.M146
12.
GerlachK.RamN.InfurnaF. J.VogelN.WagnerG. G.GerstorfD. (2017). The role of morbidity for proxy-reported well-being in the last year of life. Developmental Psychology, 53(9), 1795-1809. doi:10.1037/dev0000368
13.
HaleyW. E.RothD. L.HovaterM.ClayO. J. (2015). Long-term impact of stroke on family caregiver well-being: A population-based case-control study. Neurology, 84(13), 1323-1329. doi:10.1212/wnl.0000000000001418
14.
Institute of Medicine. (1997). Approaching death: Improving care at the end of life. The National Academies Press.
15.
KehlK. A. (2006). Moving toward peace: An analysis of the concept of a good death. American Journal of Hospice and Palliative Medicine, 23(4), 277-286. doi:10.1177/1049909106290380
16.
KrickeG.WoodsD.ArbajeA.JordanN. (2019). Nonsymptomatic factors more strongly associated with high-quality end-of-life care than symptomatic factors for community-dwelling older adults with multiple chronic conditions. Journal of Palliative Medicine, 22(5), 522-531. doi:10.1089/jpm.2018.0389
17.
Lambert SouthA.EltonJ.LietzenmayerA. M. (in press). Communicating death with humor: Humor types and functions in death over dinner conversations. Death Studies, 1-10. doi:10.1080/07481187.2020.1716883
18.
LandK. C.YangY. (2006). Morbidity, disability, and mortality. In BinstockR. H.GeorgeL. K.CutlerS. J.HendricksJ.SchulzJ. H. (Eds.), Handbook of aging and the social sciences (6 ed., pp. 41-58). Elsevier Inc.
19.
LloydA.KendallM.StarrJ. M.MurrayS. A. (2016). Physical, social, psychological and existential trajectories of loss and adaptation towards the end of life for older people living with frailty: A serial interview study. BMC Geriatrics, 16(1), 176. doi:10.1186/s12877-016-0350-y
20.
LunneyJ. R.LynnJ.FoleyD. J.LipsonS.GuralnikJ. M. (2003). Patterns of functional decline at the end of life. JAMA, 289(18), 2387-2392. doi:10.1001/jama.289.18.2387
21.
LuoM. S.LiL. W. (in press). Are self-perceptions of aging associated with health trajectories among middle-aged and older adults?The Gerontologist. doi:10.1093/geront/gnz092
22.
LuthE. A.PrigersonH. G. (2018). Associations between race and dementia status and the quality of end-of-life care. Journal of Palliative Medicine, 21(7), 970-977. doi:10.1089/jpm.2017.0638
23.
LuthE. A.PristavecT. (2020). Do caregiver experiences shape end-of-life care perceptions? Burden, benefits, and care quality assessment. Journal of Pain and Symptom Management, 59(1), 77-85. doi:10.1016/j.jpainsymman.2019.08.012
24.
McClintockM. K.DaleW.LaumannE. O.WaiteL. (2016). Empirical redefinition of comprehensive health and well-being in the older adults of the united states. Proceedings of the National Academy of Sciences, 113(22), E3071-E3080. doi:10.1073/pnas.1514968113
25.
McLaughlinS. J.JetteA. M.ConnellC. M. (2012). An examination of healthy aging across a conceptual continuum: Prevalence estimates, demographic patterns, and validity. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 67(7), 783-789. doi:10.1093/gerona/glr234
26.
MagidsonJ.VermuntJ. K. (2004). Latent calss models. In KaplanD. (Ed.), The sage handbook of quantitative methodology for the social sciences (pp. 175-198). Sage.
27.
MaloneySKFinnJBloomDLAndresenJ (1996). Personal decisionmaking styles and long-term care choices. Health Care Financing Review, 18(1), 141-155.
28.
MeierE. A.GallegosJ. V.ThomasL. P. M.DeppC. A.IrwinS. A.JesteD. V. (2016). Defining a good death (successful dying): Literature review and a call for research and public dialogue. The American Journal of Geriatric Psychiatry, 24(4), 261-271. doi:10.1016/j.jagp.2016.01.135
29.
MisselbrookD. (2014). W is for wellbeing and the who definition of health. British Journal of General Practice, 64(628), 582. doi:10.3399/bjgp14X682381
30.
OfstedalM.FisherG.HerzogA. (2005). Hrs/ahead documentation report. University of Michigan.
31.
PriceR. A.ElliottM. N. (2018). Measuring patient-centeredness of care for seriously ill individuals: Challenges and opportunities for accountability initiatives. Journal of Palliative Medicine, 21(S2), S28-S35. doi:10.1089/jpm.2017.0452
32.
RoyallD. R.CordesJ. A.PolkM. (1998). Clox: An executive clock drawing task. Journal of Neurology, Neurosurgery & Psychiatry, 64(5), 588-594. doi:10.1136/jnnp.64.5.588
33.
SaundersC. (1964). The symptomatic treatment of incurable malignant disease. Prescribers Journal, 4(4), 68-73.
34.
SharmaR. K.FreedmanV. A.MorV.KasperJ. D.GozaloP.TenoJ. M. (2017). Association of racial differences with end-of-life care quality in the United States. JAMA Internal Medicine, 177(12), 1858-1860. doi:10.1001/jamainternmed.2017.4793
35.
SteinhauserK. E.ChristakisN. A.ClippE. C.McNeillyM.McIntyreL.TulskyJ. A. (2000). Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA, 284(19), 2476-2482. doi:10.1001/jama.284.19.2476
36.
TenoJ. M.FreedmanV. A.KasperJ. D.GozaloP.MorV. (2015). Is care for the dying improving in the united states?Journal of palliative medicine, 18(8), 662-666. doi:10.1089/jpm.2015.0039
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
