Nonsymptomatic Factors More Strongly Associated with High-Quality End-of-Life Care than Symptomatic Factors for Community-Dwelling Older Adults with Multiple Chronic Conditions.

Background: Information about end-of-life goals and preferences of older adults with multiple chronic conditions (MCCs) is scarce, but necessary for prioritizing resources to care for this population. Objective: The aim of this study was to determine which end-of-life quality domains are associated with excellent overall end-of-life care quality for older adults with MCCs. Design: This study involved retrospective cross-sectional cohort analysis of secondary data derived from the National Health and Aging Trends Study (NHATS), Last Month of Life Interview. Measurements: Weighted bivariable analyses determined unadjusted relationships between overall care quality and end-of-life care quality. Weighted unadjusted and adjusted multiple logistic regression tested the association of ratings of overall care quality with the perception of quality. Results: The final analytic sample included 477 NHATS participants (weighted: 1,123,887 participants). For older adults with MCC, the rating of overall care quality was positively associated with coordination (adjusted odds ratio [aOR] 4.49; 95% confidence interval [CI]: 1.85-10.86), shared decision making (aOR 1.97; 95% CI: 1.12-3.47), respect (aOR 6.36; 95% CI: 3.23-12.52), and spiritual and emotional support (aOR 2.02; 95% CI: 1.23-3.30). We found no significant association between the rating of overall care quality and symptom management (aOR 1.49; 95% CI: 0.81-2.71). Conclusion: Given that nonsymptomatic domains ( coordination , shared decision making , respect , and spiritual and emotional support ) were most associated with high-quality end-of-life care for older adults with MCC as rated by their proxies, increased attention is needed to strengthen these aspects of care. Symptom management was unrelated to the overall quality rating, and further research is needed to illuminate the meaning of this finding.