Perceptions of end-of-life care quality among bereaved closest contacts of community-dwelling older Australians: a cross-sectional survey of the ASPREE cohort.

Background: High-quality end-of-life care (EOLC) is a recognised health and human-rights priority, yet Australian evidence largely derives from administrative data and cancer-specific, facility-based samples. Little is known about the quality of EOLC experienced by community-dwelling older adults across the full range of care settings. We assessed perceived EOLC quality and its socio-demographic and clinical correlates in this group. Methods: We conducted a cross-sectional survey of the closest contacts of deceased participants in the ASPirin in Reducing Events in the Elderly (ASPREE) study, a cohort of initially healthy, community-dwelling adults aged 70 years and older. The 32-item instrument, adapted from the UK Views of Informal Carers - Evaluation of Services, Short Form (VOICES-SF) and refined through consumer and expert review, captured overall EOLC quality and five domains (pain control, symptom control, communication, emotional peace, and support) during the final month of life. Responses were linked to prospectively collected ASPREE data. Associations were examined using Pearson chi-square or Fisher exact tests. Results: Of 432 invitations, 342 responded (79% response rate) and 341 were analysed. Overall EOLC in the last month of life was rated very good or excellent by 84% of respondents and poor or very poor by 6%. Ratings were similarly high for pain control (80%), symptom control (84%), communication (79%), emotional peace (79%), and support (81%). Overall EOLC quality did not differ significantly by age, sex, rurality, socio-economic position (IRSAD), education, place of death, cancer status, illness trajectory, or advance care planning documentation. Domain-specific differences were limited: closest contacts of younger decedents more often reported poorer communication (p = 0.009), female decedents less often achieved a sense of peace (p = 0.01), and decedents with ≤ 12 years of education were rated as better supported (p = 0.05). Conclusions: In this community-dwelling cohort of older Australians, perceived EOLC quality was uniformly high and showed no socio-economic, geographic, or diagnostic gradient, indicating that equitable, high-quality EOLC is achievable in a well-resourced population. These data provide a community-based benchmark against which disparities in less advantaged groups can be measured, and identify communication with younger families as a target for improvement.