Marital Status and Place of Death Among Older Adults: A Comparison of European Countries

TL;DR

This study compares how marital status affects where older adults die across European countries, finding that social welfare systems and regional policies influence these patterns.

Contribution

The paper provides new insights into how marriage status influences place of death across different European welfare regimes.

Findings

In Nordic countries with strong welfare systems, marital status does not affect place of death.

In Continental Europe, never-married and divorced women are less likely to die at home compared to married or widowed individuals.

Southern Europe shows higher nursing home or hospice deaths for divorced individuals, especially women.

Abstract

Marital status differences in mortality are well-established, but it is unclear how marriage shapes place of death. While most older adults prefer home deaths, hospital or hospice deaths may be necessary for those desiring intensive medical care or palliation, respectively. Associations between marital status and place of death may vary across national contexts, reflecting cultural norms and healthcare policies. We use harmonized data from waves 2 through 9 of SHARE (Survey of Health, Ageing, and Retirement in Europe), to document regional differences in the associations between marital status and place of death (as reported by proxy) in 18 European countries classified into four welfare regimes: Continental (Austria, Belgium, France, Germany, Luxembourg, Netherlands, Switzerland), Eastern (Czech Republic, Estonia, Hungary, Poland, Slovenia), Southern (Greece, Italy, Poland, Spain), and Nordic (Denmark, Sweden). Marital status is not related to place of death in Nordic countries, distinguished by strong social welfare systems. In other regions, we detect strong associations, with slight differences for men and women. For instance, in Continental Europe, never married adults were more likely than married and widowed to die in nursing home whereas widowed adults were more likely to report home deaths relative to married and divorced adults. However, home deaths were especially rare for never married and divorced women. Similarly, in Southern Europe, divorced persons, especially women, were more likely to die in nursing homes or hospice, relative to their married or widowed counterparts, who were more likely to die at home. We discuss the implications for social policy.