Association between Multimorbidity and End-of-Life Outcomes among Middle-Aged and Older Adults: Evidence from 28 Countries

Objectives: Multimorbidity poses significant challenges to the well-being of middle-aged and older adults, but its impact on end-of-life experiences remains relatively underexplored and inconsistent. This study aims to investigate the association between the number of chronic conditions and 6 end-of-life outcomes across 28 countries. Design: Longitudinal analyses. Setting and Participants: Data were drawn from 6625 participants in the Survey of Health, Ageing, and Retirement in Europe (SHARE). Methods: Information on 12 chronic non-communicable conditions was self-reported by participants in core interviews and categorized into 4 groups: 0, 1, 2, and >= 3 chronic conditions. Six end-of-life outcomes were reported by proxy respondents during end-of-life interviews after participants' deaths. These outcomes included the place of death, duration of hospital stays in the last year of life, hospice or palliative care utilization, and symptoms such as pain, breathlessness, and anxiety or sadness in the last month of life. Mixed-effects logistic regression models were conducted to examine the association between the number of chronic conditions and end-of-life outcomes. Results: Among the included participants, having 3 or more chronic conditions was positively associated with dying in a hospital [odds ratio (OR), 1.31; 95% CI, 1.15-1.49)], staying in hospitals for 3 months or more during the last year of life (OR, 1.36; 95% CI, 1.04-1.78), and experiencing symptoms such as pain (OR, 1.67; 95% CI, 1.34-2.08), breathlessness (OR, 1.32; 95% CI, 1.08-1.60), and anxiety or sadness (OR, 1.43; 95% CI, 1.12-1.83) in the last month of life after adjusting for covariates. In addition, each additional chronic condition was associated with 6% to 12% increases in the odds of these end-of-life outcomes, except for hospice or palliative care utilization. Conclusions and Implications: Our findings underscore the significant impact of multimorbidity on endof-life experiences and highlight the importance of coordinated care strategies to address the complex needs of patients with multimorbidity and alleviate their symptom burden. (c) 2024 Post-Acute and Long-Term Care Medical Association.