Kinlessness and end-of-life care quality: does race and ethnicity matter?

Close family members provide the majority of end-of-life (EoL) caregiving. However, the number of kinless older adults (defined as lacking children and a partner) is increasing. Moreover, non-White older adults are more likely to rely on close families to provide care at the EoL than their White counterparts. Therefore, we examined the association between kinlessness and the quality of EoL care among older adults and the intersectional effect of kinlessness and race/ethnicity on EoL quality.Data were derived from the combined Rounds 2-11 of the National Health and Aging Trends Study. The working sample included 3,045 older adults who were over 65 and living in the community or residential care facilities at the last interview. We used ordered logistic regression to examine both the independent effect of kinlessness and its intersection with race/ethnicity on the quality of EoL care among older adults.A total of 7.7% of decedents were kinless at the EoL. Kinless older adults were less likely to receive higher-rated EoL care than those with kin, with non-White older adults being disproportionately affected compared to their White counterparts.These results highlight a significant disadvantage for non-White kinless older adults, who had worse EoL care quality. From a policy standpoint, there is a need to invest more in supporting alternatives to the family-centered model in EoL care delivery for those without close kin.

Duke Scholars

Author Bei Wu School of Nursing