Nonsymptomatic Factors More Strongly Associated with High-Quality End-of-Life Care than Symptomatic Factors for Community-Dwelling Older Adults with Multiple Chronic Conditions.

Abstract

<b><i>Background:</i></b> Information about end-of-life goals and preferences of older adults with multiple chronic conditions (MCCs) is scarce, but necessary for prioritizing resources to care for this population. <b><i>Objective:</i></b> The aim of this study was to determine which end-of-life quality domains are associated with excellent overall end-of-life care quality for older adults with MCCs. <b><i>Design:</i></b> This study involved retrospective cross-sectional cohort analysis of secondary data derived from the National Health and Aging Trends Study (NHATS), Last Month of Life Interview. <b><i>Measurements:</i></b> Weighted bivariable analyses determined unadjusted relationships between <i>overall</i> care quality and end-of-life care quality. Weighted unadjusted and adjusted multiple logistic regression tested the association of ratings of <i>overall</i> care quality with the perception of quality. <b><i>Results:</i></b> The final analytic sample included 477 NHATS participants (weighted: 1,123,887 participants). For older adults with MCC, the rating of <i>overall</i> care quality was positively associated with coordination (adjusted odds ratio [aOR] 4.49; 95% confidence interval [CI]: 1.85-10.86), shared decision making (aOR 1.97; 95% CI: 1.12-3.47), respect (aOR 6.36; 95% CI: 3.23-12.52), and spiritual and emotional support (aOR 2.02; 95% CI: 1.23-3.30). We found no significant association between the rating of <i>overall</i> care quality and symptom management (aOR 1.49; 95% CI: 0.81-2.71). <b><i>Conclusion:</i></b> Given that nonsymptomatic domains (<i>coordination</i>, <i>shared decision making</i>, <i>respect</i>, and <i>spiritual and emotional support</i>) were most associated with high-quality end-of-life care for older adults with MCC as rated by their proxies, increased attention is needed to strengthen these aspects of care. Symptom management was unrelated to the <i>overall</i> quality rating, and further research is needed to illuminate the meaning of this finding.