Social Relationships and End-of-Life Quality among Older Adults in the United States: The Impacts of Marital, Kinship, and Network Ties.

Objectives: We examine marital status differences in recent decedents' end-of-life care and gender differences therein, and the role of other social ties (children, siblings, network members) in influencing the quality of end-of-life care.

Method: Data are from 12 waves (2011-2022) of the National Health and Aging Trends Study. We use binomial and multinomial logistic regression to evaluate the effects of marital status and other social ties on ten distinct dimensions of care in the last month of life, reported by proxies of deceased study participants. Outcomes were overall quality of care; adequately treated breathing problems, pain, and sadness/anxiety; care coordination; decisions made with patient input; care concordant with patient wishes; informed about care; personal care needs met; and respectful treatment. Models were adjusted for sociodemographic, health, and proxy characteristics.

Results: Divorced decedents fared poorly on multiple outcomes, being less likely than married or widowed persons to receive excellent care and to have personal care needs met. Divorced and widowed decedents were less likely to receive respectful treatment relative to married decedents. We found no significant gender differences in these patterns. Persons with more siblings and network members had superior pain management.

Discussion: . Our results offer modest support for marital control and compensatory frameworks; no particular social tie is uniformly protective at the end of life. Health care providers should help dying patients identify significant others who can best participate in end-of-life preparations and care. Hospital patient advocates could also aid those who lack close kin at the end of life.