Luo Shengyu, Chen Weiqing, Li Jinghua, Guo Vivian Yawei
Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China.
Department of Biostatistics, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China.
J Am Med Dir Assoc. 2025 Mar;26(3):105461. doi: 10.1016/j.jamda.2024.105461. Epub 2025 Jan 22.
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.
Longitudinal analyses.
Data were drawn from 6625 participants in the Survey of Health, Ageing, and Retirement in Europe (SHARE).
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.
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.
Our findings underscore the significant impact of multimorbidity on end-of-life experiences and highlight the importance of coordinated care strategies to address the complex needs of patients with multimorbidity and alleviate their symptom burden.
多种疾病并存给中老年人群的健康带来了重大挑战，但其对临终体验的影响仍未得到充分探索且存在不一致性。本研究旨在调查28个国家慢性病数量与6种临终结局之间的关联。
纵向分析。
数据来自欧洲健康、老龄化与退休调查（SHARE）的6625名参与者。
参与者在核心访谈中自行报告了12种慢性非传染性疾病的信息，并分为4组：0种、1种、2种和≥3种慢性病。在参与者死亡后的临终访谈中，由代理受访者报告6种临终结局。这些结局包括死亡地点、生命最后一年的住院时间、临终关怀或姑息治疗的使用情况，以及生命最后一个月的疼痛、呼吸困难、焦虑或悲伤等症状。采用混合效应逻辑回归模型来检验慢性病数量与临终结局之间的关联。
在纳入的参与者中，患有3种或更多慢性病与在医院死亡呈正相关（优势比[OR]，1.31；95%置信区间[CI]，1.15 - 1.49），在生命的最后一年住院3个月或更长时间（OR，1.36；95% CI，1.04 - 1.78），以及在调整协变量后在生命的最后一个月出现疼痛（OR，1.67；95% CI，1.34 - 2.08）、呼吸困难（OR，1.32；95% CI，1.08 - 1.60）和焦虑或悲伤（OR，1.43；95% CI，1.12 - 1.83）等症状。此外，除临终关怀或姑息治疗的使用情况外，每增加一种慢性病，这些临终结局的发生几率会增加6%至12%。
我们的研究结果强调了多种疾病并存对临终体验的重大影响，并突出了协调护理策略对于满足多种疾病并存患者的复杂需求以及减轻其症状负担的重要性。
