While literature indicates that fewer than half of older adults aged 65 years or older receive high quality end-of-life care, less is known about the quality of end-of-life care experienced by the segment of that population with multiple chronic conditions (MCC). Drawing upon the Teno Model of high quality end-of-life care, the goals of this study were to advance the understanding of the quality of end-of-life care experienced by older adults with MCC and how that care may be improved. Three specific aims addressed the study’s goals: (1) to identify disparities in end-of-life care quality by MCC status; (2) to determine which dimensions of end-of-life care quality were associated with high quality end-of-life care for older adults with MCC; and (3) to assess the association between care coordination and high quality end-of-life care for older adults with MCC. This retrospective cross-sectional cohort study utilized the nationally representative National Health and Aging Trends Study (NHATS), Last Month of Life Interview (LMLI). Results indicated that end-of-life care quality does not differ significantly by MCC status, but meaningful gaps in care exist for all older adults, particularly relating to spiritual and emotional support. We also identified that dying at home was significantly associated with higher rates of hospice enrollment, better ratings of overall end-of-life care quality, and a “positive” perception of care for several quality dimensions for the general older adult population and for older adults with MCC. In this study, ratings of overall end-of-life care quality for older adults with MCC were associated with their experience in the coordination, shared decision-making, respect, and spiritual and emotional support domains, but not their experience with symptom management. Findings also suggested that older adults with MCC who do not have cancer may experience different benefits from hospice, Medicare’s primary end-of-life care program and the gold standard for end-of-life care quality, than dying older adults with MCC that does not include cancer. Study findings identified care coordination as an end-of-life care improvement approach worth further investigation. Additionally, this study confirmed the need to improve end-of-life care quality research approaches, which currently limit the ability to improve end-of-life care quality meaningfully.

Last modified

• 04/18/2018

Creator

• Gayle Kricke

DOI

• https://doi.org/10.21985/N2N10R

Subject

• Health Sciences Integrated PhD Program

Keyword

• Multiple chronic conditions
• Quality
• End-of-life
• Aging

Date created

• 2017-01-01

Resource type

• Dissertation

Rights statement

• In Copyright