How social, psychological, and spiritual needs are supported in the last months of life: evidence from the English Longitudinal Study of Ageing end-of-life interviews

Abstract Background End-of-life care includes social, psychological, and spiritual support in addition to medical care. Population-level evidence on whether these non-medical needs are met in the last months of life, who provides such support, and how it is perceived remains limited. Methods We analysed end-of-life proxy interviews from deceased participants aged 55 years and older in the English Longitudinal Study of Ageing (n = 507). Outcomes included whether social, psychological, and spiritual needs were met in the last three months of life, and how support was provided and perceived. Analyses included multivariate probit models adjusted for sociodemographic and end-of-life factors. Findings Individuals died at a mean age of 83 years (range 55–105). Social and psychological needs were met for most individuals (81.8% and 77.8%); among those with spiritual needs (n = 227), 74.4% had these needs met. Support was provided predominantly by family members, with limited involvement of formal services, and was generally rated as good or excellent and helpful. Living alone was associated with lower probabilities of having social, psychological, and spiritual needs met, while dementia was associated with lower probabilities of having social and psychological needs met (P < .05–.01). Higher educational attainment was associated with a higher probability of having spiritual needs met (P < .05–.01). Conclusions Reliance on informal networks creates inequities in non-medical end-of-life support, particularly for older adults living alone or with dementia, underscoring the need for more integrated public health approaches.