For a study, researchers sought to identify potential lessons for the United States; they investigated the impact of family structure on the intensity of EoL experiences in Denmark, a country context designed to be particularly supportive of older adults without traditional families (characterized by high individualism, low fertility, and strong state-based support).

They explored relationships between family structure (partnership status, parent status) and the chance of having extensive EoL experiences in 137,599 people aged 60 and above who died of natural causes between 2009 and 2016. (visits to hospitals, ICUs, and EDs in the last 30 days of life). They also looked at gender disparities using multivariable logistic regression models that account for decedent sociodemographic and clinical factors, such as to cause of death. 

Unpartnered childless decedents were the least likely to attend 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. Those with and without children reported comparable more acute EoL experiences among the paired. There were no significant differences based on gender.

The findings showed an unanticipated pattern at the EoL in which unpartnered older persons, particularly unpartnered childless (“kinless”) older adults, get lower-intensity EoL care. The pattern raised various questions, including alternate options for the unpartnered, the role of children in supporting more intense care, and potentially differing interpretations of high-intensity EoL care results across nation settings.

Reference:www.jpsmjournal.com/article/S0885-3924(22)00490-0/fulltext