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Primary Submission Category: Social/relational factors
Equal Care, Unequal Suffering: Kinlessness and Stratified End-of-Life Experiences
Authors: Zheng Lian,
Presenting Author: Zheng Lian*
Kinlessness in later life has become increasingly common across many societies. Despite its growing prevalence, research on what it is like to die in this social context remains limited. Prior studies tend to treat kinlessness at the end of life as a homogeneous experience, overlooking its intersection with other social factors. This study uses data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) to examine whether and how kinlessness is associated with end-of-life symptoms and care quality. Multinomial logistic regressions were estimated to assess the relative risk of dying with undesirable end-of-life outcomes versus desirable outcomes among kinless decedents compared to those with kin. Kinlessness was also interacted separately with gender, education, and economic stability to examine moderation effects. Results show that kinlessness is associated with an 87 percent greater risk of experiencing managed pain versus no pain and a 136 percent greater risk of experiencing unmanaged pain versus no pain. No association is observed between kinlessness and receiving respectful, high-quality end-of-life care. The greater symptom burden associated with kinlessness is more pronounced among men and individuals with lower educational attainment. Economically stable kinless individuals, however, are more likely to encounter difficulties receiving respectful and high-quality care. Overall, equal care but unequal symptom burden characterizes the experiences of kinless individuals at the end of life. These findings highlight the need for interventions to address the greater symptom burden faced by kinless older adults and draw attention to the heterogeneity of dying experiences within this rapidly growing population.