How to define and quantify a bad death in palliative home care? Across-sectional and exploratory study using Canadian...

Area of Science:

• Gerontology
• Palliative Care
• Public Health

Background:

• Dying is a multifaceted process influenced by physical, social, cultural, spiritual, environmental, and interpersonal factors.
• Historically, qualitative methods dominated the exploration of bad death experiences.
• This study utilized population-level data to identify key indicators of a bad death and their predictors.

Purpose of the Study:

• To identify key indicators of a bad death in community-dwelling adults.
• To examine the predictors associated with each identified bad death indicator.
• To understand the interrelationships between various bad death indicators.

Main Methods:

• Cross-sectional analysis of routinely collected clinical and sociodemographic data from the Resident Assessment Instrument for Home Care (RAI-HC).
• Inclusion of 16,586 home care clients aged 18+ who died between April 2007 and March 2020.
• Examination of four bad death indicators: loneliness, severe depressive symptoms, severe/excruciating uncontrolled pain, and severe/excruciating daily pain, using Chi-square analyses.

Main Results:

• 33.5% of the sample experienced at least one bad death indicator.
• Significant interconnections were found between indicators, with Odds Ratios (ORs) ranging from 1.70 to 3.26.
• Psychiatric diagnoses (OR: 1.29-1.89), family/friend conflict (OR: 1.21-3.40), and distressing social interaction decline (OR: 2.06-3.70) were significant predictors.

Conclusions:

• Four bad death indicators are prevalent among community-dwelling adults.
• An interconnectedness exists between these indicators, suggesting a holistic approach to care.
• Early identification and collaborative care planning can improve end-of-life experiences and promote a good death.