How to define and quantify a bad death in palliative home care? Across-sectional and exploratory study using Canadian interRAI data

• DOI: 10.1186/s12904-025-01720-7
• Publication Date: 2025-03-20T07:26:45Z
• Authors: Amanda Mofina; Nicole Williams; John P. Hirdes; Gary Cheung; James Downar; Kieran L. Quinn; Dawn M. Guthrie
• Keywords: Cross-sectional study

Abstract Background Dying is a complex process comprised of physical, social, cultural, spiritual, environmental, and interpersonal relationship factors that contribute to both good bad death experiences. Bad deaths have historically been explored with qualitative lens. This study aimed identify key indicators examine predictors for each indicator using population-level data. Methods cross-sectional analyzed routinely collected clinical sociodemographic data the Resident Assessment Instrument Home Care (RAI-HC) between April 2007 March 2020. 16,586 home care clients aged 18 years older who died had an assessment completed within 30 days their were included. Four examined: self-reported loneliness, severe depressive symptoms, daily pain horrible or excruciating, severe/excruciating uncontrolled by medications. These interRAI specific variables captured common constructs in existing literature. The sample was separated into groups based on these four individual could populate more than one group. Chi-square analyses used potential risk indicator. Results Of total sample, 50.9% 85 + age, 54.7% female. prevalence experiencing at least 33.5%. Each significantly increased likelihood other ORs ranging from 1.70 3.26. Other important odds included: any psychiatric diagnoses (OR range: 1.29–1.89), conflict family friends 1.21–3.40), decline social interaction which distressing person 2.06–3.70). Conclusions among community-dwelling adults. found there interconnectedness indicators. Clinically, means addressing aspect may positively influence others. Early identification issues, along client collaboration, can aid optimizing death.