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Published Online: 7 August 2023

End-of-Life Experiences Among “Kinless” Older Adults: A Nationwide Register-Based Study

Publication: Journal of Palliative Medicine
Volume 26, Issue Number 8


Background: The population of older adults who are unpartnered and childless (i.e., “kinless”) is increasing across the globe, and may be at risk for lower quality end-of-life (EoL) experiences due to lack of family support, assistance, and advocacy. Yet, little research exists on the EoL experiences of “kinless” older adults.
Objectives: To document associations between family structure (i.e., presence or absence of partner or child) and intensity of EoL experiences (i.e., visits to medicalized settings before death).
Design: The study design is a cross-sectional population-based register study of the population of Denmark.
Subjects: Participants include all adults age 60 years and older who died of natural causes in Denmark from 2009 to 2016 (n = 137,599 decedents).
Results: “Kinless” older adults (reference = has partner, has child) were the least likely group to visit the hospital (two or more times; odds ratio [OR] = 0.74, confidence interval [CI] = 0.70–0.77), emergency department (one or more times; OR = 0.90, CI = 0.86–0.93), and intensive care unit (one or more times; OR = 0.71, CI = 0.67–0.75) before death.
Conclusions: “Kinless” older adults in Denmark were less likely to experience medically intensive care at the EoL. Further research is needed to understand factors associated with this pattern to ensure that all individuals receive high quality EoL care regardless of their family structure and family tie availability.

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Information & Authors


Published In

cover image Journal of Palliative Medicine
Journal of Palliative Medicine
Volume 26Issue Number 8August 2023
Pages: 1056 - 1063
PubMed: 36893217


Published online: 7 August 2023
Published in print: August 2023
Published ahead of print: 9 March 2023
Accepted: 25 January 2023


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    Department of Sociology, Anthropology, and Public Health, University of Maryland Baltimore County, Baltimore, Maryland, USA.
    Lau C. Thygesen
    National Institute of Public Health, University of Southern Denmark, Odense, Denmark.
    Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
    Djin L. Tay
    College of Nursing, University of Utah, Salt Lake City, Utah, USA.
    Katherine A. Ornstein
    Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.


    Address correspondence to: Christine A. Mair, PhD, Department of Sociology, Anthropology, and Public Health, University of Maryland Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA [email protected]

    Authors' Contributions

    C.A.M.: Conceptualization, Methodology, Writing—Original Draft, Writing—Review and Editing, Visualization; L.C.T.: Methodology, Validation, Formal Analysis, Data Curation; M.A.: Conceptualization, Writing—Original Draft, Writing—Review and Editing; D.L.T.: Conceptualization, Writing—Original Draft, Writing—Review and Editing; K.A.O.: Conceptualization, Writing—Original Draft, Writing—Review and Editing, Supervision, Project Administration, Funding Acquisition.

    Author Disclosure Statement

    No competing financial interests exist.

    Funding Information

    This work was supported by National Institute on Aging K01AG047923 to Katherine A. Ornstein and the National Palliative Care Research Center to Katherine A. Ornstein.

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