We need to tackle access to end of life care for people aged 85 and over
by Scott Sinclair Policy & Public Affairs Manager, England
In its recent report on Equity in the Provision of Palliative Care in the UK, the London School of Economics shows that people over the age of 85 receive proportionately less specialist palliative care than people from other age groups. Only 16 per cent of specialist palliative care is provided to people 85 or over, even though 39 per cent off all deaths occur within this age group. By contrast, people in the 25 to 64 age group comprise only 13 per cent of deaths but make up 29 per cent of people who access specialist palliative care. Moreover, just over 54 per cent of people who access specialist care are in the 65 to 85 age group, though this age group accounts for only 46 per cent of deaths.
Why this is happening
There are several possible explanations for this situation. Firstly, people over the age of 85 are less likely to have a cancer diagnosis, which means, as the LSE report shows, that they are less likely to have access to specialist palliative care. Secondly, it's possible that people over the age of 85 under-report their care needs both to the people looking after them and researchers, though this hypothesis has not been tested. Thirdly, healthcare professionals are not always able to identify the need for palliative care in older people. In a recent study, medical staff estimated that only 15.5 per cent of people in a group of 514 people over the age of 85 had a palliative care need, when in fact 36 per cent had a need for high-quality palliative care. Lastly, we know that healthcare professionals report confusion about who is responsible for providing palliative care for people over the age of 85, particularly with regard to the role of geriatricians.
These are significant challenges, especially as, with our ageing population, there will be more people over the age of 85 who need, and should be able to access, good palliative care. There is a large onus on healthcare professionals here to ensure that they are able to assess when someone over the age of 85 needs palliative care, even if there are barriers to communication. They also need to ensure they act in a co-ordinated way with their colleagues to ensure their patients over 85 have an equal opportunity to access palliative care. On top of all this, people over the age of 85 are more likely to experience emergency admissions to hospital. Without real change, we are heading towards a situation in which more people over the age of 85 die in hospital, despite this being the place where so few of us (less than 5 per cent) would want to end our lives. With the NHS under real and long-term financial pressure, this situation is simply not sustainable. Take a look at our campaign page to see how you can get involved in helping Marie Curie provide a better life for people and their families living with a terminal illness, regardless of age.