Very old people dying – what would relatives like to have seen managed differently?

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Abstract

Background and aim

As people live longer, dying in very old age is becoming more common. Palliative care is trying to adapt, from models that evolved predominantly from cancer care origins, to better meet the needs and priorities of frail older people. From one of the longest-running studies of ageing1 we have already described disability and cognition in the last year of life of a population-representative sample of men and women who died aged ≥852 and their end-of-life place of care transitions,3,4 showing most died away from home, with markedly higher dependency levels amongst people dying ≥90. From interviews with relatives after the study participants’ deaths, reportedly dying comfortably was associated with avoiding transitions, particularly with staying in care homes that had become home.5 Qualitative research in the same study found participants aged ≥95 were willing to discuss their end-of-life care preferences.6 We also sought to understand bereaved family members’ perspectives on their ‘older old’ relatives’ deaths.

Methods

Analysis (framework approach) of n = 295 informant interview responses to an open question ‘If you had to live through the time of […participant’s…] final illness again, would you like anything to have been managed differently?’ regarding n = 290 deceased participants (mean age at death 90.2, SD 5.1 years) in the Cambridge City over-75s Cohort study, UK.

Results

We will detail our findings that highlighted four key themes: communication (information-sharing, inter-personal/professional understanding), time (responsiveness, constraints), place (staying, moving, continuity) and care (in all settings).

Discussion

Training and service integration implications for end-of-life care for society’s ‘oldest old’ will be discussed.

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