ArticleJournal of the American Geriatrics Society2021
A national profile of kinlessness at the end of life among older adults: Findings from the Health and Retirement Study.
Article in Journal of the American Geriatrics Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it, 40 citations in OpenAlex.
- Understanding attendance patterns and determinants in cardiac, pulmonary, and ICU rehabilitation/recovery programs: A systematic review and meta-analysis.Heart & lung : the journal of critical carePooled it
- Support exchange between siblings in later life: the role of "core-kinlessness" and geographic proximity.The journals of gerontology. Series B, Psychological sciences and social sciences · 2026Article
- Caregiver Availability and Racial Differences in End-Of-Life Care Quality: Evidence From the National Health and Aging Trends Study 2017-2024.Journal of the American Geriatrics Society · 2026Article
- Family structure, "Kinlessness", and cognitive decline: Social connectedness and contextual variation in Europe.Social science & medicine (1982) · 2026Article
- Structural determinants of Medicaid enrollment in late life.The journals of gerontology. Series B, Psychological sciences and social sciences · 2026Article
- Association between advance care planning combined with super-enhanced transitional care and outcomes of facility death and bed availability in a Japanese geriatric health services facility.Journal of rural medicine : JRM · 2026Article
- Kinlessness and end-of-life care quality: does race and ethnicity matter?The journals of gerontology. Series B, Psychological sciences and social sciences · 2025Article
- Use of Paid Family Care in the Community: National Trends Among Older Adults With Functional Impairment, 2011-2022.Journal of the American Medical Directors Association · 2025Article
- Social relationships and end-of-life quality among older adults in the United States: the impacts of marital, kinship, and network ties.The journals of gerontology. Series B, Psychological sciences and social sciences · 2025Article
- The need for scientific leadership and collaboration to enhance social connection: A call to action.Annals of the New York Academy of Sciences · 2025Article
- "Kinlessness," Social Connectedness, and Subjective Well-Being in Europe.The journals of gerontology. Series B, Psychological sciences and social sciences · 2025Article
- Understanding deep disadvantage at the end of life: A nationwide analysis of unclaimed deaths.Social science & medicine (1982) · 2025Article
- "You've Got a Lot to Prove": A Mixed Methods Analysis of How Older Adults and Their Families Navigate Medicaid Enrollment.Social policy & administration · 2024Article
- Kinlessness at Older Ages: Prevalence and Heterogeneity in 27 Countries.The journals of gerontology. Series B, Psychological sciences and social sciences · 2024Article
- Social Isolation and Hospitalization in Community-Dwelling Older Adults by Dementia Status.The journals of gerontology. Series A, Biological sciences and medical sciences · 2024Observational
- Health Outcomes of Elder Orphans: An Umbrella and Scoping Review of the Literature.Journal of population ageing · 2024Article
- Proactive Care-Seeking Strategies Among Adults Aging Solo With Early Dementia: A Qualitative Study.The journals of gerontology. Series B, Psychological sciences and social sciences · 2024Article
- Article
- Disparities and determinants of place of death: Insights from the Utah Population Database.Death studies · 2024Article
- Family Ties and Older Adult Well-Being: Incorporating Social Networks and Proximity.The journals of gerontology. Series B, Psychological sciences and social sciences · 2023Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
BACKGROUND/
objectivesThe majority of end-of-life (EOL) caregiving is provided by unpaid family members. An increasing number of older adults are kinless (without close family/partnerships) and may have insufficient caregiver support to remain at home at the EOL. We therefore determined what proportion of older adults are kinless at the EOL and assessed the association of kinlessness with EOL care.
designRetrospective analysis of Health and Retirement Study decedents, 2002-2015.
settingUS population-based sample.
participantsDecedents age 51+ who died within 1 year of interview (n = 3844) and subset who are community-dwelling at last interview. MEASUREMENTS: Kinlessness was defined as lacking a spouse/partner and children. Primary outcome measure was location of death. Secondary outcome measures included contextual EOL measures such as symptom burden and caregiver support.
resultsA total of 7.4% of decedents were kinless at the EOL. Kinless decedents were more likely to be female, nonwhite, enrolled in Medicaid, living alone, or living in a nursing home prior to death. Although community-dwelling kinless decedents received fewer hours of caregiving per week at the EOL (34.7 vs. 56.2, p < 0.05) and were more likely to die in nursing homes (18.1% vs. 10.3%, p < 0.05) than those with kin, they did not have higher EOL symptom burden or treatment intensity (e.g., intensive care unit use). In multinomial logistic analysis controlling for demographic and illness characteristics, kinless decedents living in the community before death had a twofold increased risk of dying in the nursing home (odds ratio [OR] = 2.02 [95% confidence interval (CI) = 1.09-3.72]) and a trend toward increased risk of hospital death (OR = 1.60 [95% CI = 0.96-2.69]) versus home setting.
conclusionsKinless individuals are more likely to die in nursing homes, even if they are living in the community in their last year of life. Expanded long-term care services and policies are needed to enable all older adults regardless of their family support systems to receive high-quality EOL care.
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