Home, Palliative Care Units or Hospice, and Hospital Deaths: An Analysis of the Canadian Longitudinal Study on Aging

Objective: The setting in which death occurs significantly shapes the quality of end-of-life experiences. We aimed to understand how dying in different settings (home, hospital, or hospice or palliative care units [PCU]) influences the quality of the dying experience. Methods: We conducted a secondary analysis of decedent interview data from the Canadian Longitudinal Study on Aging, between January 2012 and March 2022. Proxies of deceased participants provided information on end-of-life experiences. We examined quality of death indicators across various locations and analyzed associations between end-of-life characteristics and the location of death. Results: Among the 1287 participants with completed decedent questionnaires, 17.2% (n = 222) of deceased participants died in hospice or PCU, 49% (n = 631) died in hospital and 22.7% (n = 292) died at home. Those who died at home died in their preferred place more frequently (89.4; standard difference (SD): 0.65), while individuals who died in PCU or hospice reported significantly lower levels of pain (81.5%; SD: 0.31). Dying in the Canadian province of Quebec (odds ratio [OR] 3.77; CI 2.28-6.37), dying of cancer (OR 6.79; CI 4.10-11.9), and having total physical impairment (OR 2.08; CI 1.41-3.08) increased the odds of dying in PCU or hospice. Conclusions: Dying in PCU or hospice may allow participants to die peacefully and have their pain under control, though dying at home aligns more closely with individual preferences, suggesting a potential compromise between quality and location of death. Regional health and social policies may influence where older individuals die.