Factors influencing home-based death among older adults in mainland China: An application of Andersen behavioral model

In recent years, there has been a growing trend for older adults to die at home, reflecting evolving societal values and advancements in palliative care. This study aimed to explore the factors influencing the choice of home-based death among older adults in mainland China using the Andersen model, which considers predisposing, enabling, need, and social factors. Data from the 2008-2014 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were utilized. The study sample included 10,747 decedents, with logistic regression analysis conducted to examine the association between home death and various factors. The results showed that older age and living in rural areas were associated with a higher likelihood of home-based death. Higher family income was positively associated with home death, while medical expenses borne by the decedents and their families were negatively associated. Decedents with more chronic diseases were less likely to die at home, while those with a better peaceful experience were more prone to die at home. Moreover, if the decedents were mainly cared by their spouses and their children or grandchildren and their spouses before death, they were less likely to die at home. The study highlights several social factors associated with home death, such as the role of primary caregiver and financial responsibility for medical expense. These insights provide a roadmap for policymakers to develop targeted interventions and for healthcare providers to create more personalized care plans, enhancing the quality of end-of-life care for older adults in China.

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