Family and professional care leave different end-of-life gaps across 32 countries
An observational study compared end-of-life assistance for 21,423 older people with activity limitations across 32 countries. Professional care and family support played different roles across the surveyed settings, with institutional death associated with less unmet formal care in some regions. Receiving assistance did not measure its overall quality. Retrospective family reports and differences among surveys constrain the cross-country comparison.
Science··Midday
Assistance varies between family and formal services
An international observational study examines unmet end-of-life care among older adults with activity limitations, separating professional services from assistance by relatives and other informal carers. The comparison covers different care systems rather than assigning people to a common intervention.[1], [2]
Five harmonized aging surveys supplied data on 21,423 people aged 65 or older across 32 countries. Observations covered 2010–2021 and included people with at least one limitation in their final year. Activities ranged from bathing and dressing to shopping and housework.[1]
Institutional and family support differ by setting
Institutional death was associated with less unmet formal care in the United States, Europe and South Korea. In China and Mexico, family assistance was more prominent and professional provision more limited. Mexico’s association between institutional death and overall unmet care differed in direction from several other regions. People could receive both formal and informal help, so those categories overlapped. Childlessness and marital status also had different associations across settings.[1]
Receiving help does not rate its adequacy
The measured unmet need meant receiving no assistance despite a limitation. It did not score the quality or completeness of help received. Models accounted for age, education and health, but people were not randomly assigned to institutions. Relatives supplied some information after a death, creating possible recall bias. Differences in survey questions further constrain the comparison of care arrangements and leave causal explanations unresolved.[1]
