End-of-Life Experiences and Quality of Dying in Canada: An Analysis of the Canadian Longitudinal Study on Aging Decedent Questionnaire

Abstract

Background: Understanding the factors that contributed to a peaceful and dignified death was essential for improving end-of-life (EoL) care in Canada. Despite ongoing efforts to enhance palliative and hospice services, variations persisted in the quality of death experiences based on location, medical decisions, and personal characteristics. Objectives: This thesis examined the personal and end-of-life factors associated with peace with dying among older adults in Canada. It also explored how location of death and the consideration or receipt of medical assistance in dying (MAiD) influenced the perceived quality of death and dying. Methods: A secondary analysis of data from the Canadian Longitudinal Study on Aging (CLSA) was conducted. The study included next-of-kin interviews of deceased CLSA participants who died between June 2016 and March 2022. Logistic regression was used to assess the association between demographic, clinical, and EoL characteristics and peace with dying. Additionally, the impact of location of death and MAiD on various quality-of-death indicators, including dying with dignity, dying without pain, and dying in one’s preferred place, was examined. Results: Among 3,672 deceased CLSA participants, 1,287 (35.0%) had completed next-of-kin interviews and were included in the analysis. While 66% were reported to have experienced peace with dying, 17% did not. Individuals who were widowed, had an appointed substitute decision-maker, or died of cancer were more likely to experience peace with dying. Those who died at home were more likely to pass away in their preferred location, while individuals in palliative care units or hospices experienced lower levels of pain. Of the decedents, 25.4% had considered MAiD, and 6.7% had received it. Those who considered or received MAiD were more likely to die in their preferred location and experience a positive death process as reported by their next of kin. Conclusion: Nearly one in five older Canadians did not experience peace with dying, highlighting the need to improve EoL care services. While dying at home aligned with individual preferences, hospice and palliative care settings better addressed pain management. MAiD appeared to enhance the quality of dying for those who pursued it. These findings underscored the importance of advanced care planning and patient-centered EoL interventions to ensure dignified and peaceful deaths across care settings in Canada.