Changes in end-of-life care models among Chinese older adults, 1998-2018: an age-period-cohort analysis.

BACKGROUND: As China’s older population continues to grow and unhealthy life expectancy gradually extends, the demand for end-of-life care has surged. However, research on end-of-life care models for Chinese older adults is still limited. This study explores the changes in end-of-life care models for older adults in China. METHODS: We utilized data from 22,464 deceased older adults in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018. End-of-life care models were determined based on the primary caregivers and living arrangements of the older adults during the end-of-life period. Using a hierarchical age-period-cohort (HAPC) model, we analyzed the trends in age, period, and cohort for different care models, and examined gender and urban-rural differences. RESULTS: With increasing age at the end of life, the probability of spousal care showed a downward trend, care provided by grandchildren showed an upward trend, care provided by relatives and friends followed a U-shaped curve, and there were no significant changes in the probability of care provided by children or formal care. The analysis of period effects revealed fluctuating upward trends in spousal care and care provided by children, while the remaining three care models showed downward trends. No significant cohort effects were observed for any of the care models. Regardless of age or period effects, older men were generally more likely to receive spousal care and care provided by relatives and friends than older women, while older women were more likely to receive care provided by children and grandchildren than older men. Urban-rural differences in both age and period effects exhibited varying trends across different care models. CONCLUSIONS: The changes in end-of-life care models for Chinese older adults are influenced by both age and period effects. The sustainability of the child-centered care model, influenced by filial piety culture, is facing challenges, as the responsibility for end-of-life care has gradually expanded from children to a broader circle of caregivers. Future efforts should focus on developing a care model based on family caregiving, supplemented by formal care services. Additionally, older women and rural older adults are still at a disadvantage in accessing care services, and future policies should address this issue.