Palliative Care in Shanghai Communities: Needs, Influencing Factors and Preferences Among Older Adults with Chronic Diseases

<b>Background:</b> Palliative care plays a vital role in enhancing the quality of life of older adults with chronic diseases, while service coverage in China remains limited. Shanghai faces increasing demand due to its rapidly aging population and high prevalence of chronic diseases. However, little is known about the needs, influencing factors, and care preferences of community-dwelling older adults. This study aimed to assess palliative care needs in this population and to identify associated determinants and care preferences. <b>Methods:</b> A cross-sectional survey was conducted among community-dwelling older adults with chronic diseases in Shanghai. Data on sociodemographic information, palliative care needs and preferences were collected. Descriptive analyses were used to summarize participant characteristics, chi-square tests assessed group differences, and logistic regression models examined predictors of palliative care needs. <b>Results:</b> A total of 611 older adults participated, of whom 6.5% were identified as having palliative care needs. Dependency in activities of daily living (<i>p</i> = 0.024) and poorer self-rated health (<i>p</i> = 0.001) were significantly associated with increased palliative care needs. Participants demonstrated a greater preference for comfort-oriented care for themselves than for family members. Gender differences were observed in care setting preferences: females were more likely to favor palliative care institutions, while males tended to choose non-palliative care wards in general hospitals. <b>Conclusions:</b> Even in Shanghai, where palliative care services are relatively advanced compared with other regions of China, awareness and utilization remain low among older adults with chronic conditions. Functional decline and negative self-rated health are associated with palliative care needs, underscoring the importance of incorporating functional and health assessments into community health services to identify eligible individuals earlier. The observed discrepancy between self- and family-oriented preferences, alongside gendered differences in care setting choices, highlights the need for culturally sensitive communication and tailored service provision. Expanding community-based palliative care and increasing public education may help align services with the needs and preferences of older adults in China.