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Outcomes
1. Outline risks faced by “kinless” older adults (those who lack a partner or a child) at the end of life
2. Outline the component of a “family-based model of care” and list examples of how this model may exacerbate inequality for women, unpartnered individuals, and the childless
Importance
Cross-nationally, end-of life (EoL) care systems are highly reliant on families to provide and facilitate support. Yet relying on and promoting family-based care at the EoL ignores the growing global population of individuals without traditional family ties (e.g., unpartnered or childless adults), often referred to as “kinless.” “Kinless” older adults are at risk for higher-intensity EoL experiences (e.g., more visits to hospitals, intensive care units, emergency departments).
Objective(s)
We examine the impact of family structure on intensity of EoL experiences in a country context designed to be particularly supportive of older adults without traditional family—Denmark (characterized by high individualism, low fertility, and strong state-based support)—to identify potential lessons for the United States.
Method(s)
We analyze civic registry data of 137,599 individuals aged 60+ who died of natural causes (2009-2016) to examine associations between family structure (partnership status, parent status) and likelihood of having intensive EoL experiences (visits to hospitals, ICUs, and EDs in last 30 days of life). We also examine differences by sex, using multivariable logistic regression models adjusting for decedent sociodemographic and clinical characteristics, including cause of death.
Results
Unpartnered childless decedents were the least likely to visit the hospital (OR = 0.74, CI = 0.70-0.77), ED (OR = 0.90, CI = 0.86-0.93), and ICU (OR = 0.71, CI = 0.67-0.75), followed by unpartnered parents. Among the partnered, those with and without children had similarly more intense EoL experiences. There were no major differences by sex.
Conclusion(s)
Our results reveal an unexpected pattern at the EoL wherein unpartnered older adults, especially unpartnered childless (“kinless”), experience lower-intensity EoL care. This pattern raises several considerations, including alternative support options for the unpartnered, the role of children in facilitating more intensive care, and potentially different interpretations of high-intensity EoL care outcomes across country contexts.
Impact
These results suggest that family structure impacts EoL experiences in unique ways and call into question the limited lens of family-based care in the context of changing demographics globally.
Article info
Identification
Copyright
© 2022 Published by Elsevier Inc.
