, Bojan Miletić , Željko JovanovićThe aging of the population is a global demographic trend that we can also observe in Croatia. This brings additional challenges for individuals, families, and communities. One of the most important goals is to extend life expectancy and increase the number of healthy life years. It is therefore important to ensure high-quality end-of-life care, which means that we need to understand what matters most to patients, families, and caregivers. The main aim of the study was to investigate the preferred type of care during the last days of life among older adults over 60 years of age. A cross-sectional survey was conducted among outpatient healthcare users in Istria County (Croatia). 106 older adults took part in the survey, of which 72 (67.9%) were women and 34 men (32.1%) between the ages of 60 and 98. The results show that older adults in Istria County would rather spend the last days of their lives at home than in a hospital. The older adults who prefer hospitalization at the end of their lives cite reasons such as fear of dying alone and burdening the family. In addition to comprehensively and continuously improving the quality of life of older adults, healthcare systems should take more time to ensure a dignified end of life, i.e., working toward ensuring that the last moments of a person’s life, as well as death itself, take place exactly where the individual wishes, and that each individual is treated holistically in meeting their needs and improving palliative care at home.
1. Državni zavod za statistiku (Croatian Bureau of Statistics).
https://dzs.gov.hr/ (accessed 2025-03-18).
2. Vuletić, G. and Stapić, M. Kvaliteta života i doživljaj usamljenosti kod osoba starije životne dobi (Quality of life and the experience of loneliness in older adults). Klin. Psihol., 2013, 6, 45–61.
3. Akdeniz, M., Yardımcı, B. and Kavukcu, E. Ethical considerations at the end-of-life care. SAGE Open Med., 2021, 9.
https://doi.org/10.1177/20503121211000918
4. Xia, Q., Kularatna, M., Virdun, C., Button, E., Close, E. and Carter, H. E. Preferences for palliative and end-of-life care: a systematic review of discrete choice experiments. Value Health, 2023, 26(12), 1795–1809.
https://doi.org/10.1016/j.jval.2023.07.005
5. Bloomer, M. J. End-of-life care. In Encyclopedia of Gerontology and Population Aging (Gu, D. and Dupre, M. E., eds). Springer, Cham, 2021, 1655–1665.
https://doi.org/10.1007/978-3-030-22009-9_747
6. Pinto, S., Lopes, S., de Sousa, A. B., Delalibera, M. and Gomes, B. Patient and family preferences about place of end-of-life care and death: an umbrella review. J. Pain Symptom Manag., 2024, 67(5), e439–e452.
https://doi.org/10.1016/j.jpainsymman.2024.01.014
7. Jedvaj, S., Štambuk, A. and Rusac, S. Demografsko starenje stanovništva i skrb za starije osobe u Hrvatskoj (Demographic ageing of the population and care for the elderly in Croatia). Socijal. teme, 2014, 1(1), 135–154.
8. Havelka, M. Zdravstvena psihologija (Health Psychology). Naklada Slap, Jastrebarsko, 1998.
9. Harmell, A. L., Jeste, D. and Depp, C. Strategies for successful aging: a research update. Curr. Psychiatry Rep., 2014, 16(10), 476.
https://doi.org/10.1007/s11920-014-0476-6
10. Waddell, C., Van Doorn, G., Power, G. and Statham, D. From successful ageing to ageing well: a narrative review. The Gerontologist, 2025, 65(1), gnae109.
https://doi.org/10.1093/geront/gnae109
11. Husu, E. N. Older and better: a narrative review of successful aging and adaptation to pain in late life. Pain Physician, 2024, 27(7), E651–E659.
https://doi.org/10.36076/ppj.2024.27.E651
12. Brajković, L. Kvaliteta života u trećoj životnoj dobi nakon umirovljenja (Quality of life in the old age after retirement). In Kvaliteta života i zdravlje (Quality of Life and Health) (Vuletić, G., ed.). Filozofski fakultet Sveučilišta u Zagrebu, Osijek, 2011.
13. Duraković, Z. Gerijatrija: medicina starije dobi (Geriatrics: Medicine of Old Age). C. T. ‒ Poslovne informacije, Zagreb, 2007.
14. Stephens, M. A. EDF statistics for goodness of fit and some comparisons. J. Am. Stat. Assoc., 1974, 69(347), 730–737.
https://doi.org/10.2307/2286009
15. McHugh, M. L. The chi-square test of independence. Biochem. Med., 2013, 23, 143–149.
https://doi.org/10.11613/BM.2013.018
16. NCBI Bookshelf. Aging and the Macroeconomy: Long-Term Implications of an Older Population.
https://www.ncbi.nlm.nih.gov/books/NBK148831/ (accessed 2025-03-18).
17. Štambuk, A. Jasminka Despot Lučanin: iskustvo starenja. Doprinos teoriji starenja (Jasminka Despot Lučanin: the experience of aging. Contribution to the theory of aging). Rev. Soc. Polit., 2003, 10(2), 235–237.
https://doi.org/10.3935/rsp.v10i2.129
18. Državni zavod za statistiku (Croatian Bureau of Statistics). Demografska slika Europe – starenje stanovništva (Demography of Europe ‒ an ageing population).
https://web.dzs.hr/demography/bloc-1c.html?lang=hr/ (accessed 2025-03-18).
19. Clancy, A., Simonsen, N., Lind, J., Liveng, A. and Johannessen, A. The meaning of dignity for older adults: a meta-synthesis. Nurs. Ethics, 2021, 28(6), 878–894.
https://doi.org/10.1177/0969733020928134
20. Glyn-Blanco, M. B., Lucchetti, G. and Badanta, B. How do cultural factors influence the provision of end-of-life care? A narrative review. Appl. Nurs. Res., 2023, 73, 151720.
https://doi.org/10.1016/j.apnr.2023.151720
21. Csikai, E. L. and Maynard, Q. R. How do older adults define a good death? A scoping review. Midwest Soc. Sci. J., 2024, 27(1), 20‒36.
https://doi.org/10.22543/2766-0796.1121
22. Poslon, L. Ljudsko dostojanstvo i kraj života (Human dignity and the end of life). Obnovljeni Život, 2022, 77(2), 235–248.
https://doi.org/10.31337/oz.77.2.7
23. Laklija, M., Rusac, S. and Žganec, N. Trendovi u skrbi za osobe starije životne dobi u Republici Hrvatskoj i u zemljama Europske Unije (Trends in the care for the elderly in the Republic of Croatia and EU countries). Rev. Soc. Polit., 2008, 15(2), 171–188.
https://doi.org/10.3935/rsp.v15i2.743
24. Tucak Junaković, I. and Nekić, M. Percepcija uspješnog starenja u starijih osoba (Perception of successful ageing in older adults). Acta Iadert., 2016, 13(2), 0–0.
https://doi.org/10.15291/ai.1304
25. Huffman, J. L. and Harmer, B. End-of-life care.
http://www.ncbi.nlm.nih.gov/books/NBK544276/ (accessed 2025-03-18).
26. The Max Planck Society. Dying in hospital.
https://www.mpg.de/12545175/declining-trend-but-not-for-everyone/ (accessed 2025-03-18).
27. Bone, A. E., Gomes, B., Etkind, S. N., Verne, J., Murtagh, F. E. M., Evans, C. J. et al. What is the impact of population ageing on the future provision of end-of-life care? Population-based projections of place of death. Palliat. Med., 2018, 32(2), 329–336.
https://doi.org/10.1177/0269216317734435
28. ONS (Office for National Statistics). Deaths at home increased by a third in 2020, while deaths in hospitals fell except for COVID-19.
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/deathsathomeincreasedbyathirdin
2020whiledeathsinhospitalsfellexceptforcovid19/2021-05-07/ (accessed 2025-03-18).
29. Meng, Z., Cheng, L., Hu, X. and Chen, Q. Risk factors for in-hospital death in elderly patients over 65 years of age with dementia: a retrospective cross-sectional study. Medicine (Baltimore), 2022, 101(26), e29737.
https://doi.org/10.1097/md.0000000000029737
30. Barbiellini Amidei, C., Macciò, S., Cantarutti, A., Gessoni, F., Bardin, A., Zanier, L. et al. Hospitalizations and emergency department visits trends among elderly individuals in proximity to death: a retrospective population-based study. Sci. Rep., 2021, 11(1), 21472.
https://doi.org/10.1038/s41598-021-00648-1
31. Hrvatski zavod za javno zdravstvo (Croatian Institute of Public Health). Hrvatski zdravstveno-statistički ljetopis za 2023. g. – tablični podaci (Croatian Health Statistical Yearbook for 2023 – Tabular Data).
https://www.hzjz.hr/hrvatski-zdravstveno-statisticki-ljetopis/hrvatski-zdravstveno-statisticki-ljetopis-za-2023-g-tablicni-podaci/ (accessed 2025-03-18).
32. Warraich, H. J., Hernandez, A. F. and Allen, L. A. How medicine has changed the end of life for patients with cardiovascular disease. J. Am. Coll. Cardiol., 2017, 70(1), 1276–1289.
https://doi.org/10.1016/j.jacc.2017.07.735
33. NCBI Bookshelf. Approaching Death: Improving Care at the End of Life.
https://www.ncbi.nlm.nih.gov/books/NBK233604/ (accessed 2025-03-18).
34. Hrvatski zavod za javno zdravstvo (Croatian Institute of Public Health). Izvješće o smrtnosti prema listi odabranih uzroka smrti u 2023 (Report on mortality by selected causes of death in 2023).
https://www.hzjz.hr/periodicne-publikacije/izvjesce-o-smrtnosti-prema-listi-odabranih-uzroka-smrti-u-2023/ (accessed 2025-03-18).
35. Hrvatski zavod za javno zdravstvo (Croatian Institute of Public Health). Izvješće – rad bolnica u Hrvatskoj u 2023. godini (Report – hospital work in Croatia in 2023).
https://www.hzjz.hr/periodicne-publikacije/izvjesce-rad-bolnica-u-hrvatskoj-u-2023-godini/ (accessed 2025-03-18).
36. Pennec, S., Gaymu, J., Riou, F., Morand, E., Pontone, S., Aubry, R. et al. A majority of people would prefer to die at home, but few actually do so. Popul. Soc., 2015, 524(7), 1–4.
https://doi.org/10.3917/popsoc.524.0001
37. Aguilar García, C. Almost 90 more people died at home every day than expected in past year.
https://www.theguardian.com/society/2022/sep/24/almost-90-more-people-died-at-home-every-day-than-expected-in-past-year/ (accessed 2025-03-18).
38. Pennec, S., Monnier, A., Pontone, S. and Aubry, R. End-of-life medical decisions in France: a death certificate follow-up survey 5 years after the 2005 act of parliament on patients’ rights and end of life. BMC Palliat. Care, 2012, 11, 25.
https://doi.org/10.1186/1472-684X-11-25
39. Carr, D. and Luth, E. A. Well-being at the end of life. Annu. Rev. Sociol., 2019, 45, 515–534.
https://doi.org/10.1146/annurev-soc-073018-022524
40. Ministarstvo zdravstva Republike Hrvatske (Ministry of Health of the Republic of Croatia). Nacionalni plan razvoja zdravstva za razdoblje od 2021. do 2027. godine (National plan for the development of health care for the period 2021–2027).
https://zdravlje.gov.hr/UserDocsImages/2022%20Objave/Nacionalni%20plan%20razvoja%20zdravstva%202021.-2027..pdf (accessed 2025-03-18).
41. Sinha, A. and Vashisht, R. End-of-life evaluation and management of pain.
http://www.ncbi.nlm.nih.gov/books/NBK568753/ (accessed 2025-03-18).
42. Morrison, L. J. and Morrison, R. S. Palliative care and pain management. Med. Clin. North Am., 2006, 90(5), 983–1004.
https://doi.org/10.1016/j.mcna.2006.05.016
43. Rummans, T. A., Bostwick, J. M. and Clark, M. M. Maintaining quality of life at the end of life. Mayo Clin. Proc., 2000, 75(12), 1305–1310.
https://doi.org/10.4065/75.12.1305
44. Gomes, B., Higginson, I. J., Calanzani, N., Cohen, J., Deliens, L., Daveson, B. A. et al. Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. Ann. Oncol., 2012, 23(8), 2006–2015.
https://doi.org/10.1093/annonc/mdr602
45. Rodrigues, R., Simmons, C., Zólyomi, E., Vafaei, A., Rehnberg, J., Kadi, S. et al. Depends on whom you ask: discordance in reporting spousal care between older women and men across European welfare states. Arch. Gerontol. Geriatr., 2024, 125, 105518.
https://doi.org/10.1016/j.archger.2024.105518
46. Fenton, M. R., Hoppmann, C. A., Boger, J., Dalton, B. H., Komisar, V., Sakakibara, B. M. et al. Growing older at home: Canadians’ meaning of aging in place. J. Aging Environ., 2024, 1, 23.
https://doi.org/10.1080/26892618.2024.2329869
