Quality of death among older adults with and without comorbid dementia: A nationwide mortality follow-back study.

BACKGROUND

The prevalence of dementia in older adults is increasing, and deficiencies in end-of-life (EOL) care have been reported. Nonetheless, evidence of dementia as a comorbidity across diseases remains limited. This study aimed to compare the EOL outcomes between older adults with and without comorbid dementia across major causes of death.

METHODS

A secondary analysis was conducted using data from a nationwide mortality follow-back survey of bereaved families in Japan that included 45,509 decedents aged ≥65 years. The outcomes were the quality of death (QOD), symptom burden, and EOL discussions. Logistic regression analysis was performed for the five leading causes of death, with primary analyses on cancer and heart disease.

RESULTS

Overall, QOD domains differed. Among decedents with cancer and dementia, adjusted odds for awareness of one's future condition (adjusted odds ratio: 0.29, 95% confidence interval: 0.27-0.32), communication with loved ones (0.47, 0.44-0.50), sense of meaning (0.55, 0.53-0.61), and preferred place of care (0.67, 0.63-0.72) were lower, whereas adjusted odds for freedom from physical distress (1.34, 1.26-1.43) were higher. A similar pattern was observed in heart disease, with lower odds for awareness of one's future condition (0.31, 0.25-0.40) and communication with loved ones (0.44, 0.36-0.54). Patients with dementia had fewer discussions regarding their preferred care settings and EOL care. Dysphagia was more frequently reported, whereas pain and insomnia were less frequently reported.

CONCLUSION

Comorbid dementia was linked to poorer QOD and EOL communication, underscoring the need for dementia-inclusive care planning and clinician education.