Impact of disease type and temporal trends on the proximity of palliative care initiation to death in older adults: a population-based study

Abstract

Background Chronic conditions like heart disease and dementia have surpassed cancer as leading causes of death in aging populations. Non-cancer patients, despite similar palliative care needs, often face delayed initiation or limited access. This study investigated the proximity of palliative care initiation to death among older adults with different diagnoses and influencing factors. Methods This cross-sectional study used Taiwan’s National Health Insurance and Multiple Causes of Death databases (2010–2020), including individuals aged ≥65 who received specialist palliative care before death. Multinomial logistic regression analysed the association of cancer status and year of death with the proximity of palliative care initiation to death. Results Among 177 403 decedents, 82.41% had cancer and 17.59% non-cancer diagnoses. While median proximity was similar (cancer: 29 days; non-cancer: 28 days), non-cancer decedents had significantly higher adjusted odds ratios (aORs) for late palliative care initiation, particularly ≤3 days (aOR: 1.45, 95% CI: 1.36–1.54) and 4–7 days before death (aOR: 1.34, 95% CI: 1.27–1.41). Over time, the proportion of decedents who initiated palliative care at least 181 days before death increased. Those who died in 2020 were significantly more likely to receive earlier palliative care than those who died in 2010 (aOR: 7.64, 95% CI: 5.78–10.10). Conclusions Despite a trend towards earlier initiation for both groups, non-cancer patients in Taiwan are more likely to have palliative care initiated in the final days of life. Targeted policies are needed to ensure equitable, needs-based palliative care across diagnoses for improved end-of-life outcomes for older adults.