scholarly journals Kinlessness at Death: Examining End-of-Life Outcomes With Danish Registry Data

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 603-604
Author(s):  
Christine Mair ◽  
Katherine Ornstein ◽  
Melissa Aldridge ◽  
Lau Thygesen
Keyword(s):  
End Of Life ◽  
Healthcare System ◽  
Healthcare Reform ◽  
Registry Data ◽  
Low Fertility ◽  
Life Outcomes ◽  
Family Structures ◽  
Medical Treatments ◽  
Marriage Rates

Abstract Demographic changes that lead to “kinlessness” such as low fertility and low marriage rates are not a recent phenomenon for the countries of Northern Europe, such as Denmark. Characterized by small family sizes, high individualism, and a highly formalized healthcare system that is less dependent on family caregivers, Denmark presents a useful case study for the analysis of end-of-life outcomes among the “kinless.” We analyze the population of decedents aged 50 and older (N=175,755) using Danish civil registry data. Approximately 15% of those who died in Denmark had no living partner and no living child. Danish decedents’ family structures are associated with multiple end-of-life outcomes, including number of hospitalizations, ICU visits, and use of specific medical treatments—but not always in the direction hypothesized. Denmark’s highly formalized and individualized healthcare system may offer insight regarding healthcare reform in countries that have yet to complete the second demographic transition.

scholarly journals Kinlessness and Social Isolation at the End of Life: Cross-National Comparisons

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 603-603
Author(s):  
Christine Mair ◽  
Katherine Ornstein ◽  
Feinian Chen
Keyword(s):  
Older Adults ◽  
Family Structure ◽  
End Of Life ◽  
Social Isolation ◽  
Life Outcomes ◽  
Family Structures ◽  
Marriage Rates ◽  
Location Of Death ◽  
Demographic Shifts ◽  
Cross National

Abstract Nearly all older adults cross-nationally rely on close family members to facilitate care at the end-of-life, but recent demographic shifts toward declining fertility and marriage rates have yielded an unprecedented increase in older adults who lack traditional family ties (“kinless”). “Kinless” older adults may be at risk for social isolation, lack of caregiving options, and poorer end-of-life outcomes, and these risks may be buffered or exacerbated by social and economic resources as well as country context. Because the potential impact of “kinlessness” on end-of-life outcomes cross-nationally is unknown and virtually unstudied, this symposium composed of overlapping, interdisciplinary research teams investigate if and how “kinlessness” is associated with end-of-life outcomes cross-nationally. Mudrazija and Ornstein analyze a sample of older European adults (SHARE) to predict location of death (e.g., home deaths) by family size, living alone, and size of social network. Plick, Ankuda, and Ornstein examine a sample of older American decedents (HRS) to predict end-of-life outcomes (e.g., hours of care received, location of death). Mair, Ornstein, Aldridge, and Thygesen explore associations between family structure and multiple end-of-life outcomes (e.g., hospitalizations, ICU visits, medical treatment) among the population of decedents aged 50+ from Denmark. Finally, Mair, Ornstein, Calvo, Donoso, and Medina explore family structure, social isolation, loneliness, and end-of-life outcomes among a sample of older adults from 20 countries (Gateway to Global Aging). These papers will be discussed by Feinian Chen, a family sociologist and social demographer who specializes in cross-national comparisons of older adults’ family structures, country context, and health.

scholarly journals Kinlessness, Loneliness, and End of Life: A Cross-National Comparison of 20 Countries

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 604-604
Author(s):  
Esteban Calvo ◽  
Christine Mair ◽  
Katherine Ornstein ◽  
Rosario Donoso ◽  
José Medina
Keyword(s):  
Older Adults ◽  
Family Structure ◽  
End Of Life ◽  
Well Being ◽  
Life Outcomes ◽  
National Data ◽  
Family Structures ◽  
National Comparison ◽  
Pooled Sample ◽  
Cross National

Abstract Countries across the globe are experiencing declining rates of fertility and marriage, which present a distinct challenge for older adults’ social integration, well-being, and end-of-life care. However, older adults who are “alone” (e.g., no partner, no child) may not be lonely, and end-of-life risks faced by “kinless” older adults likely vary significantly by country context. Using harmonized, cross-national data from 20 countries (United States (HRS), England (ELSA), and European Union (SHARE)), we examine associations between family structure, loneliness, and end-of-life outcomes. Although “kinless” family structures are associated with greater loneliness in the pooled sample, the percent of “kinless” who report no signs of loneliness ranges from 7% (Greece) to 56% (Denmark). Family structure is associated with various end-of-life outcomes, and these associations vary by country—likely reflecting differences in healthcare structure. We discuss distinctions between “being alone,” “being lonely,” and “being without care” in light of cross-national variation.

scholarly journals The Sibsize Revolution in International Context. Declining Social Disparities in the Number of Siblings in 26 Countries

2018 ◽  
Author(s):  
Patrick Präg ◽  
Seongsoo Choi ◽  
Christiaan Willem Simon Monden
Keyword(s):  
Twentieth Century ◽  
Low Fertility ◽  
Social Disparities ◽  
Life Outcomes ◽  
Sibship Size ◽  
Family Structures ◽  
International Context ◽  
Life Chances ◽  
The Us ◽  
Nationally Representative

One's number of siblings is an important determinant for many life outcomes such as educational attainment. The US has experienced a 'sibsize revolution' in the last century, in which sibship sizes declined and which led to a convergence in family circumstances for children. Did this happen in other countries as well? This study examines the development of sibship size and social disparities in sibship size in low-fertility countries across the twentieth century. We analyze sibship size data collected from 111 nationally representative surveys conducted in 26 low-fertility countries across the twentieth century. Average sibship sizes have declined in virtually all countries. Average sibship sizes are socially stratified, with smaller sibship sizes among higher-educated parents. This social disparity in sibship size has declined over time, indicating convergence in most countries. This convergence takes place for large families, but not for only-child families. Siblings are an understudied phenomenon in family demography, despite their growing importance in a time of increasingly complex family structures. Given the significance of sibship size for children's educational outcomes and overall life chances, decreasing social disparities in sibship size suggest greater equality in the intergenerational transmission of advantage.

Childhood trauma, attachment style, and a couple's experience of terminal cancer: Case study

2010 ◽  
Vol 8 (2) ◽  
pp. 227-233 ◽  
Author(s):  
Linda M. McLean ◽  
Sarah Hales
Keyword(s):  
End Of Life ◽  
Childhood Trauma ◽  
Attachment Style ◽  
Multidisciplinary Team ◽  
Marital Distress ◽  
Empirical Literature ◽  
Cancer Case ◽  
Terminal Cancer ◽  
Team Approach

AbstractObjective:The primary objective of this article is to elucidate the significance of psychosocial distress and risk in a sub-population of end-stage cancer patients and their spouse caregivers who present with an especially challenging attachment style and histories of childhood trauma. The case study presented highlights the need to both identify and offer an empirically validated couple–based intervention, along with a multi-disciplinary team approach over the trajectory of the illness and at end of life.Method:A validated marital protocol (emotionally focused couple therapy [EFT]) is modified for this population and conducted by an EFT-trained psychologist as part of a pilot investigation as to the feasibility and effectiveness of EFT for the terminal cancer population. Measures of marital distress, depression, hopelessness, and attachment security are completed at baseline and subsequent intervals, as reported in another publication. Attachment insecurity and the exquisitely intimate relationship with caregiving and care receiving are underscored, given the couple's traumatic childhood history.Results:The couple described herein, followed from diagnosis of metastatic disease to end of life illuminates the potential effectiveness of a modified EFT protocol, and underscores the need to both identify and intervene with a population potentially at significantly high risk for marital distress, suicidality, depression, and hopelessness.Significance of Results:The benefits of a multidisciplinary team is evident as the patient's symptoms of physical distress increased toward end of life and she returned to earlier behaviors, namely suicidal ideation and an attempt to alleviate her experience of suffering. The strength of the marital bond, possibly as a result of the intervention, and the efforts of the multidisciplinary team approach, demonstrate potential to mitigate a catastrophic end of life and a complicated spousal bereavement. This case study adds to the current empirical literature in an area that is currently under-studied and under-reported.

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