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9 September 2022

The impact of language discordance on end-of-life outcomes among Chinese residents in ethnic and non-ethnic long-term care homes

Amy Hsu , Bruyère Research Institute , Canada

Abstract

Background: Members of ethnic minority groups are known to experience disparities in care quality and health outcomes. However, less is known about differences in health outcomes experienced by minority residents in long-term care (LTC) homes, which have been the epicentre of the COVID-19 pandemic.

Objectives: To examine the outcomes of Chinese residents in ethnically Chinese LTC homes (where there is language-concordant care) compared to Chinese residents in non-ethnic LTC homes (where there is possible language-discordant care) before the COVID-19 pandemic.

Methods: We conducted a population-based retrospective cohort study capturing deceased individuals aged above 65 years residing in LTC homes in Ontario, Canada (N=19,055). The study timeframe was between March 2019 and December 2019. For this analysis, ethnically Chinese homes included those formally designated and licensed as ethnic LTC homes and facilities where there is a greater than 20% of residents whose primary language was Chinese. Primary outcomes included: any burdensome transitions to acute care near the end of life, the experience of pain and pain management in the final six months of life, and the location of death. We estimated random intercept models to account for the hierarchical data structures and examine variations in outcomes between LTC homes.

Results: Of the 19,055 deceased LTC residents, there were 262 Chinese residents in ethnically Chinese homes (1.4%) and 161 Chinese residents in non-ethnic LTC homes (0.8%). In general, Chinese residents were more likely to experience a burdensome transition and be hospitalized in the last three days of life (14.9% of Chinese residents in ethnically Chinese homes and 13.7% of Chinese residents in non-ethnic LTC homes, compared to 8.4% across all LTC residents in Ontario). Predictably, Chinese residents were less likely to die in LTC (62.2% of Chinese residents in ethnically Chinese homes and 62.1% of Chinese residents in non-ethnic LTC homes, compared to 76.9% across all LTC residents in Ontario). While they were more likely to be transferred to acute care in the last three days of life, Chinese residents receiving care in a language-concordant environment were less likely to report moderate-to-severe pain in the last six months of life (2.7% of Chinese residents in ethnically Chinese homes vs. 8.7% of Chinese residents in non-ethnic LTC homes), and less likely to be prescribed or given opioids for pain (24.8% of Chinese residents in ethnically Chinese homes and 27.3% of Chinese residents in non-ethnic LTC homes) in the last two weeks of life. Results from the random intercept models indicate that 25.1% of the observed variation in the experience of moderate-to-severe pain can be attributed to facility-level differences. In comparison, just 5.2% and 11.2% of the observed variation in hospitalization in the last three days of life and death in acute care, respectively, were attributable to facility-level differences.

Conclusions: The results suggest that Chinese residents were more likely to be hospitalized and die in acute care settings than non-Chinese residents. However, receiving care in language-concordant settings may be associated with better pain management at the end of life.


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