Multiple Chronic Conditions and High Quality End-of-Life Care

Objective (1) To describe the end-of-life care experienced by older adults with multiple chronic conditions (MCC) (2) To evaluate the relationship between MCC status and proxy-reported rating of overall end-of-life care quality and specific quality-related subdomains. Methods Retrospective cross-sectional cohort analysis of secondary data derived from the National Health and Aging Trends Study (NHATS), Last Month of Life Interview (LMLI). Bivariable analyses were conducted using the Wald statistic to determine unadjusted relationships between MCC status and the following outcomes: (1) excellent rating of overall care quality, and (2) perception of care for recognized dimensions of quality. Multiple logistic regression compared unadjusted and adjusted ratings of care quality for older adults with MCC to those without MCC. Appropriate survey weights were applied to all analysis. Results The final analytic sample included 665 participants, which represented 1,572,166 Medicare beneficiaries when weighted (77% with MCC, 23% without). MCC was associated with reporting greater breathing issues (aOR 1.60; 95% CI: 1.05-2.43) and more anxiety or sadness (aOR 1.59; 95% CI: 1.02-2.46) in the last month of life. Overall end-of-life care quality was rated as “not excellent” by 49% of MCC proxies. The proportion of MCC proxies who reported care as “not positive” varied by composite quality domain: coordination (15%), symptom management (29%), shared decision-making (22%), respect (25%), and spiritual and emotional support (69%). MCC was not significantly associated with the rating of overall care quality in unadjusted or adjusted models. Conclusion Findings from this study show that while end-of-life care quality does not differ significantly for older adults based on their MCC status, end-of-life care quality is lacking for all older adults, particularly for spiritual and emotional support. Findings from this study confirm previous analysis, which showed that end-of-life care quality for older adults needs to be improved. This study contributes important information for key stakeholders such as end-of-life care providers, hospital administrators, and policymakers on the specific care needs of dying older adults with MCC and gaps in care that exist for dying older adults with MCC. As a growing number of older adults reach the end of life with MCC, it is important to be mindful of the population’s specific needs and allocate resources to meet them.