Enhancing End–of–Life Care Quality and Achieving a Good Death for the Elderly in Japan

Background In the context of an aging populations, there is an escalating need for palliative care tailored to the needs of the elderly. This study aimed to assess differences in symptoms and good death among the elderly, along with the structures and processes involved in end–of life care, and to explore the impact of age on achieving a good death. Methods We conducted a questionnaire survey for bereaved family members of patients with cancer, heart disease, stroke, pneumonia, and kidney failure in 2019 and 2020. The study population was categorized into the following age groups: ≤64, 65–74, 75–84, and ≥85. The outcomes included symptom intensity, achievement of a good death, and receipt of quality care. Results In total, 62,576 bereaved family members agreed to participate in the survey (response rate; 54.0%). The weighted percentages of 'severe' and 'very severe’ symptoms decreased with age. These trends were observed across age groups, even among the elderly. The strongest effect of age on achieving a good death was found for 'feeling that life is complete’ with reference to those aged ≤64 years: 65–74 years (odds ratio [OR]; 2.09, 95% CI; 1.94 to 2.25), 75-84 years (OR; 4.86, 95% CI; 4.52 to 5.22) and ≥85 years (OR; 12.8, 95% CI; 11.9 to 13.8). Conclusion Age-specific differences were observed in quality of death, quality of care, and symptom intensity. It is important to provide individualized consideration for each age group rather than categorizing them broadly as the elderly when caring for them.