Very old people dying – what would relatives like to have seen managed differently?
Authors: Fleming Jane , Evans Robert , Scheibl Fiona , Buck Jackie , Barclay Stephen , Farquhar Morag , Brayne Carol ,   Cambridge City over-75s Cohort (CC75C) study collaboration
Published: August 2016

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 ageing1we have already described disability and cognition in the last year of life of a population-representative sample of men and women who died aged ≥852and their end-of-life place of care transitions,3,4showing 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.5Qualitative research in the same study found participants aged ≥95 were willing to discuss their end-of-life care preferences.6We 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.

References

Fleming J, Zhao E, O’Connor DW,et al.Cohort profile: the Cambridge City over-75s Cohort (CC75C).I J Epidemiol2007;36(1):40–46.http://ije.oxfordjournals.org

Zhao J, Barclay S, Farquhar M,et al.The “oldest old” in the last year of life: population-based findings from CC75C study participants aged at least 85 at death.J Am Geriatr Soc2010;58(1):1–11

Fleming J, Zhao J, Farquhar M, Brayne C, Barclay S. Place of death for the ‘oldest old’: ≥85-year-olds in the CC75C population-based cohort.Br J Gen Pract2010;60(573):171–179

Perrels AJ., Fleming J, Zhao J,et al. Place of death and end-of-life transitions experienced by very old people with differing cognitive status: retrospective analysis of a prospective population-based cohort aged 85 and over.Palliat Med2014;28(3):220–233

Fleming J, Calloway R, Perrels A,et al. Dying comfortably in very old age with or without dementia – a representative “older old” population study.Palliat Med2016a;30(4):S36.http://pmj.sagepub.com/content/30/4/S1.full.pdf+html

Fleming J, Farquhar M, Brayne C, Barclay S. Death and the oldest old: attitudes and preferences for end-of-life care – qualitative research within a population-based cohort study.PLoS ONE2016b;11(4):e0150686