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Very old people dying – what would relatives like to have seen managed differently?
  1. Jane Fleming1,
  2. Robert Evans1,
  3. Fiona Scheibl1,
  4. Jackie Buck2,
  5. Stephen Barclay1,
  6. Morag Farquhar1,
  7. Carol Brayne1,
  8. Cambridge City over-75s Cohort (CC75C) study collaboration1
  1. 1University of Cambridge, UK
  2. 2University of East Anglia, UK

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.

References

  1. Fleming J, Zhao E, O’Connor DW, et al.Cohort profile: the Cambridge City over-75s Cohort (CC75C). I J Epidemiol 2007;36(1):40–46. http://ije.oxfordjournals.org

  2. 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 Soc 2010;58(1):1–11

  3. 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 Pract 2010;60(573):171–179

  4. 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 Med 2014;28(3):220–233

  5. 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 Med 2016a;30(4):S36. http://pmj.sagepub.com/content/30/4/S1.full.pdf+html

  6. 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 ONE 2016b;11(4):e0150686

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