Background Death is a universal phenomenon that is an intrinsic part of the human experience and a cornerstone of clinical science, yet little is known about how Canadians experience death.^1-3 We examined novel data from the Canadian Longitudinal Study on Aging to describe peace with dying among older Canadians and examine correlates.⁴

Methods We conducted a secondary analysis of decedent interview data from the Canadian Longitudinal Study on Aging (CLSA) in Canada. Next of kin and proxies of deceased CLSA participants were interviewed and reported on the End-of-Life (EoL) experiences of participants who died between January 2012 to March 2022. We examined EoL characteristics, including the location of death, cause of death, arrangements for health care decision making, and arrangements for end-of-life care decision making and their association with dying peacefully. Regression methods identified the association between demographic and EoL characteristics in experiencing peace with dying.

Results There were 3,672 total deceased participants at the CLSA and 1,287 had completed a decedent questionnaire. Sampled decedents (55.3%) were 75 years old or older at death, 62.0% were male, 62.7% were married, and 39.7% died of cancer. Next of kins reported that 66.0% of the deceased experienced peace with dying, 7.0% were ‘somewhat’ at peace with dying, and 17% did not experience peace with dying. A peaceful death was more likely if the deceased was older (75+; OR 1.55; CI 1.04–2.30), widowed (OR 1.53; CI 1.12–2.10), died of cancer (OR 1.71; CI 1.27–2.30), died in hospice/palliative care (OR 1.67; CI 1.19–2.37) and having an appointed EoL decision making power of attorney (OR 1.80; CI 1.39–2.33).

Conclusions Many older Canadian do not experience peace with dying which underscores the greater public need and demand for health system focus on improving the quality of death.^{5 6} Our findings support the presumption of effectiveness for end-of-life programs as well as programs that include advanced planning regarding wishes and decision making as potentially modifiable factors to support quality of death. A person’s experience with close family member death, predictability of course of illness, and strength of close social bonds are less modifiable factors that can support how end of life programs are designed and targeted.

References

1. Ko E, Kwak J, Nelson-Becker H. What constitutes a good and bad death?: Perspectives of homeless older adults. Death Studies. 2015;39:422–32.

2. Georges JJ, Onwuteaka-Philipsen BD, van der Heide A, van der Wal G, van der Maas PJ. Symptoms, treatment and ‘dying peacefully’ in terminally ill cancer patients: a prospective study. Support Care Cancer. 2005;13:160–8.

3. Teno JM, FreedmanV. A., Kasper, J. D., Gozalo P., Mor, V. Is care for the dying improving in the United States? Journal of palliative medicine. 2015;18:662–6.

4. Van Soest-Poortvliet MC, van der Steen JT, Zimmerman S, Cohen LW, Munn J, Achterberg WP, et al. Measuring the quality of dying and quality of care when dying in long-term care settings: a qualitative content analysis of available instruments. J Pain Symptom Manage. 2011;42:852–63.

5. De Roo ML, van der Steen, J. T., Galindo Garre, F., Van Den Noortgate, N., Onwuteaka-Philipsen, B. D., Deliens, L., EURO IMPACT.When do people with dementia die peacefully? An analysis of data collected prospectively in long-term care settings.Palliative Medicine. 2014;28:210–9.

6. Diaconu V, Ouellette, N., Camarda, C. G., Bourbeau, R.Insight on ‘typical’longevity: An analysis of the modal lifespan by leading causes of death in Canada. Demographic Research. 2016; 35:471–504.