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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. [ABSTRACT FROM AUTHOR]

Purpose: The death of a close family member is commonly accompanied by intense grief, stress, and loss of social support. We hypothesized that recent bereavement would be associated with an increase in symptom exacerbations among adults with serious mental illness (SMI) whose partners or parents had died. Patients and Methods: Adults whose partners and parents had died in Denmark between January 1, 2010, and June 30, 2016, were identified using linked population-based registries. History of SMI was defined as having a diagnosis of schizophrenia and schizoaffective disorders, major depression, and bipolar disorder in the five years preceding their family member's death in the Danish Psychiatric Central Research Register using International Classification of Diseases-10 codes. The odds of SMI exacerbation (ie, attempt or completion of suicide or psychiatric hospitalization) among partners and children in the first two years after death in 3-month intervals were estimated with generalized estimating equations. Results: 12.8% of partners and 15.0% of adult children with a history of SMI experienced any SMI exacerbation two years after bereavement. Among bereaved partners, older age (80+ years) was associated with a lower risk of experiencing an SMI exacerbation compared with partners aged 18– 49 years (ORadj=0.29, [0.18– 0.45]). Partners with a history of SMI had significantly increased odds of SMI exacerbations three months after their partners' death compared to prior to their partners' death (ORadj = 1.43, [1.13– 1.81]). There was no evidence that adult children with SMI experience increased SMI exacerbations after the death of their parents compared to prior to death. Conclusion: Adults with a history of SMI whose partners had died are at increased risk for an SMI exacerbation post bereavement. Additional bereavement resources and support should be provided to those with a history of SMI, especially in the period immediately after death. [ABSTRACT FROM AUTHOR]

We aimed to examine the association of young and middle-aged sibling bereavement with use of health services and risk of developing mental health disorders over 24 months before and after sibling's death. All persons aged 18–56 years who died of illness/natural causes between 2009 and 2016 were identified in the Danish Register of Causes of Death. The study sample included 31,842 bereaved siblings and 31,842 age- and sex-matched controls. Overall, the largest effect was observed for increased use of psychological services: For women, the peak was observed 4–6 months after the death (odds ratio (OR) = 3.31, 95% confidence interval (CI): 2.85, 3.85) and for men in the first 3 months after the death (OR = 2.63, 95% CI: 2.06, 3.36). The peak of being diagnosed in a hospital setting with any mental disorder for women was observed in the period 13–15 months after sibling death (OR = 1.52, 95% CI: 1.11, 2.07) and for men in the first 3 months after the death (OR = 1.75, 95% CI: 1.32, 2.32). Young and middle-aged adults who experienced the death of a sibling are more likely to use health services and are at risk of poorer mental health outcomes. During the bereavement process, young and middle-aged siblings are especially in need of mental health support, such as professional psychological counseling. [ABSTRACT FROM AUTHOR]

Background: Seriously ill individuals rely heavily on family caregivers at the end of life. Yet many do not have family support. Aim: To characterize the size and composition of decedents' family networks by cause of death, demographic, clinical, socioeconomic, and geographic characteristics. Design: A cross-sectional population-level study with data collected from nation-wide registers. Setting/participants: All adults in Denmark born between 1935 and 1998 who died of natural causes between 2009 and 2016 were linked at the time of death to living adult spouses/partners, children, siblings, parents, and grandchildren. Results: Among 175,755 decedents (median age: 68 years, range: 18–81 years), 61% had a partner at the time of death and 78% had at least one adult child. Ten percent of decedents had no identified living adult family members. Decedents with family had a median of five relatives. Males were more likely to have a spouse/partner (65%) than females (56%). While 93% of decedents dying of cancer had adult family, only 70% of individuals dying of dementia had adult family at the time of death. The majority of cancer decedents co-resided or lived within 30 km of family (88%), compared to only 65% of those dying from psychiatric illness. Conclusions: While the majority of adults had an extensive family network at the time of death, a substantial proportion of decedents had no family, suggesting the need for non-family based long-term service and support systems. Assessment of family networks can expand our understanding of the end-of-life caregiving process and inform palliative care delivery. [ABSTRACT FROM AUTHOR]

Purpose: Bereavement is associated with increased morbidity and mortality, but few studies have examined the specific timing of depression onset. This study examines the risk of developing new-onset depression in adult children and partners by month, 1 year before and after death. Methods: Using population-based registers in Denmark, we assembled a cohort of 236,000 individuals who died a natural death (2010–2016). Partners and adult children of the deceased were identified and demographic and prescription data were collected. GEE logistic regression was used to model whether the bereaved received a new antidepressant prescription around the death of their loved one across 24 time intervals (12 months before and after death). Results: Male and female partners had an increase in receipt of new antidepressant prescriptions in the 11 months after the death of their partner, with a peak increase 2 or 3 months after death. Partners also increased new antidepressant prescription use 2 months before death. Characteristics of the decedents including cause of death were not associated with new antidepressant prescription in the surviving partner. Adult children did not have increased odds of being prescribed new antidepressants at any time. Conclusion: Both male and female partners have increase in new antidepressant utilization before and after the death of their partner. Our work points to the importance of supporting partners not only after the death of their partner, but also in the period before death when families may be actively engaged in caregiving for the seriously ill. [ABSTRACT FROM AUTHOR]

1. Outline risks faced by "kinless" older adults (those who lack a partner or a child) at the end of life 2. Outline the component of a "family-based model of care" and list examples of how this model may exacerbate inequality for women, unpartnered individuals, and the childless Cross-nationally, end-of life (EoL) care systems are highly reliant on families to provide and facilitate support. Yet relying on and promoting family-based care at the EoL ignores the growing global population of individuals without traditional family ties (e.g., unpartnered or childless adults), often referred to as "kinless." "Kinless" older adults are at risk for higher-intensity EoL experiences (e.g., more visits to hospitals, intensive care units, emergency departments). We examine the impact of family structure on intensity of EoL experiences in a country context designed to be particularly supportive of older adults without traditional family—Denmark (characterized by high individualism, low fertility, and strong state-based support)—to identify potential lessons for the United States. We analyze civic registry data of 137,599 individuals aged 60+ who died of natural causes (2009-2016) to examine associations between family structure (partnership status, parent status) and likelihood of having intensive EoL experiences (visits to hospitals, ICUs, and EDs in last 30 days of life). We also examine differences by sex, using multivariable logistic regression models adjusting for decedent sociodemographic and clinical characteristics, including cause of death. Unpartnered childless decedents were the least likely to visit the hospital (OR = 0.74, CI = 0.70-0.77), ED (OR = 0.90, CI = 0.86-0.93), and ICU (OR = 0.71, CI = 0.67-0.75), followed by unpartnered parents. Among the partnered, those with and without children had similarly more intense EoL experiences. There were no major differences by sex. Our results reveal an unexpected pattern at the EoL wherein unpartnered older adults, especially unpartnered childless ("kinless"), experience lower-intensity EoL care. This pattern raises several considerations, including alternative support options for the unpartnered, the role of children in facilitating more intensive care, and potentially different interpretations of high-intensity EoL care outcomes across country contexts. These results suggest that family structure impacts EoL experiences in unique ways and call into question the limited lens of family-based care in the context of changing demographics globally. [ABSTRACT FROM AUTHOR]